meningioma tumors presentation include definition, causes, symptoms, and treatment options prepared by Abbas Wael Abbas supervised by Dr Jawad Ziyadah ( neurosurgeon)

1. Meningioma
Prepared by : Abbas Abbas
Supervised by: Dr. Jawwad Zyadah

2. Definition
A meningioma is a tumor that arises from
a layer of tissue that covers the brain and
spine
arise from the arachnoid "cap" cells of the
arachnoid villi in the meninges
Usually benign

3. Causes
Most are sporadic, some familial
More common in women
Radiation increase risk of developing meningioma
Trauma and viruses. However, no definitive proof has yet been
found
The role of inflammation (eg, posttraumatic insult) resulting in
the upregulation of COX-2
Cell phone use increases the risk of meningiomas

4. Genetic causes:
1-NF2 gene
2-Loss of chromosome 10
3-Monosomy of chromosome 7
4-smo gene
5-Gorlinand Rubinstein-Taybi syndromes

5. Symptoms
oAsymptomatic
Meningiomas produce their symptoms by several
mechanisms:
1-Irritation: seizures
2-Compression: Localized or nonspecific headaches
are common, focal weakness, dysphasia
3-Vascular
4-skull my be invaded and present as bulging mass

6. Stereotypic symptoms

7. Miscellaneous
oIntraventricular meningiomas may present with
obstructive hydrocephalus
oMeningiomas in the vicinity of the sella turcica may
produce panhypopituitarism
oMeningiomas that compress the visual pathways
produce various visual field defects, depending on their
location.
oRarely, chordoid meningiomas can present with
hematologic disturbances, namely Castleman
syndrome

8. Locations
Parasagittal/falcine (25%(
Convexity (surface of the brain(
(19%(

9. Sphenoid ridge (17%(
Suprasellar (9%(

10. Posterior fossa (8%(
Olfactory groove (8%(

11. Middle fossa 4%
Tentorial (3%(
Peri-torcular (3%(

12. Workup
Laparotomy studies : No specific laboratory tests are
used to screen for meningioma.
Imaging study:
oCT scan
oMRI
oAngiography
oPET

13. Workup
Histology
oGrade 1 - Benign: These very slow-growing tumors
oGrade 2 - Atypical: Usually slow-growing but can recur
oGrade 3 - Anaplastic: More malignant, faster-growing

14. Treatment
Observation: Meningiomas are often slow growing, increasing
is size only 1-2 mm per year.
oPatients with small tumors and mild or minimal symptoms,
no impact on quality of life, and little or no swelling in
adjacent brain areas.
oOlder patients with very slowly progressing
symptoms. Related seizures can be controlled with
medication.

15. Treatment
Medical care
It is restricted either to perioperative drugs or to medications
that are used after all other means of treatment have failed
ocorticosteroids
oAntiepileptic
ochemotherapy
oRadiotherapy
oStereotactic radiosurgery

16. Treatment
Surgical care:
The constant principles in meningioma resection are the following:
oIf possible, all involved or hyperostotic bone should be removed
oThe dura involved by the tumor as well as a dural rim that is free from
tumor should be resected
oDural tails that are apparent on MRI are best removed, even though
some may not be involved with the tumor
oMake a provision for harvesting a suitable dural substitute
(pericranium or fascia lata). The surgeon also can use commercially
available dural substitutes
oIf feasible, always start by coagulating the arterial feeders to the
meningioma

17. Treatment
Minimally invasive surgical options
Endoscopic removal of meningiomas through the nose
oolfactory groove meningiomas
otuberculum sella meningiomas
osellar meningiomas
Keyhole microsurgical removal using eyebrow incision
oolfactory groove meningiomas
osphenoid wing meningiomas
Endoport removal
ointraventricular meningiomas

18. Yalow line; closed by
occupation
Red line ; alternative way

19. ‫لكم‬ ‫شكرا‬