gms | German Medical Science

Objective: A long time it was thought that distant metastases in meningiomas are rare and occur only in malignant tumors (WHO grade III). Review of the literature and our patient show that metastases are more common and also occur in meningiomas of WHO grade I or II. Despite lack of guidelines, few treatment options exist and have been published for recurrent and metastatic meningioma. The most promising treatments include mifepristone, hydroxyurea, tyrosine kinase inhibitors such as sunitinib, doxorubicin and trabectedin.

Methods: We report on a 48-year-old male patient who has initially had surgical treatment of a temporal meningioma in an external hospital and radiation of the orbit. He presented with a meningioma spanning from temporal to the orbit, the pterygopalatine fossa, the cavernous sinus and the cerebellopontine angle with compression of the brainstem. We performed re-resection of the temporal tumor and resection of the tumor in the cerebellopontine angle. Histopathology revealed an atypical meningioma WHO grade II. Since the patient had respiratory failure during the clinical course, a CT scan was performed showing pulmonary, hepatic, spinal and osseous metastases. We considered systemic treatment with trabectedin which the patient did not receive as he deteriorated rapidly.

Metastases in meningioma are a rare phenomenon. Metastases occur in WHO grade I in 33.9%, in grade II in 20.9 %, and in grade III in 40%. Metastatic lesions are located most frequently in the lung (37.2%), bones (16.5%), intraspinally (15.2%), and in the liver (9.2%). Few treatments have been used and published for recurrent and metastatic meningiomas. Agents used were mifepristone, hydroxyurea, tyrosine kinase inhibitors, doxorubicin and trabectedin.

Results: Meningiomas are common intracranial tumors derived from meningothelial cells. Typically, they show a benign clinical course. However, a few cases with a malignant behavior such as metastatic disease have been described. The lack of guidelines for metastatic meningiomas remains a major challenge in the management of these cases.

Conclusion: The medical records of the patient who is presented in the case report were analyzed. For the review of the literature we used PubMed with the search items "meningioma AND metastasis", "meningioma AND metastases" and "metastatic meningioma".