Meningioma presentation by dr,Mumtaz Ali narejo
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Meningioma is described in detail its origin , type , presentation and management
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A 15-year-old female presented with neck pain radiating to the scapular blade for 4 months and progressive weakness starting in the left side 4 months ago and right side 3 months ago. On examination, she had weakness, increased tone and reflexes more on the left side. Imaging showed an extramedullary tumor at the upper cervical spine. She underwent a posterior midline laminectomy with microscopic dissection and excision of the tumor. Post-operatively, she was monitored for complications like nerve root injury, spinal cord injury, CSF leak, or tumor recurrence.
Spinal ependymoma (case presentation)dr.mumtaz ali
A 22-year-old male presented with a 1-year history of back pain and 8 months of lower limb weakness and difficulty walking. MRI revealed a tumor in the lower dorsal spine. The patient underwent a posterior midline approach and excision of the tumor. Possible diagnoses included ependymoma, astrocytoma, or tuberculosis of the spine. The surgery aimed to prevent further neurological dysfunction and cure the condition through complete tumor resection.
Spinal meningioma (case presentation)dr.mumtaz ali
A 25-year-old female presented with a one-year history of lower back pain radiating to both legs. Examination revealed decreased pinprick sensation in the left leg. MRI showed a tumor at L5. The diagnosis was cauda equina syndrome secondary to a spinal meningioma at L5. The patient underwent posterior laminectomy and excision of the tumor. Post-operatively, the patient's pain improved.
Right sphenoid wing meningioma (case presentation)dr.mumtaz a li
A 28-year-old female presented with a 1-year history of headaches and 1-month history of double vision. Examination found double vision in the right upper and lower visual fields. Imaging revealed a right frontotemporal mass, and the patient underwent a right pterional craniotomy for total excision of a sphenoid wing meningioma. Post-operatively, the patient received follow-up care and rehabilitation with the goal of reducing risk of recurrence.
Orbital tumor (case presentation)dr.mumtaz ali
This document describes the medical history and examination of a 28-year-old female patient presenting with proptosis of the right eye and decreased vision in that eye for 3 years. On examination, protrusion of the right eyeball was noted. Vision was reduced to finger counting in the right eye compared to 6/6 in the left eye. Neurological examination was normal except for slight restriction of abduction of the right eyeball. The patient was admitted for further investigation and management of a suspected orbital tumor.
Olfactory groove meningioma(case presentation) dr.mumtaz ali
A 45-year-old female presented with a 1-year history of headaches and recent onset of vision loss, smell loss, and urinary incontinence. Examination found visual impairment, anosmia, and papilledema in one eye with optic atrophy in the other. Imaging revealed a likely anterior skull base tumor involving the frontal lobe, with differential diagnoses including meningioma, pituitary adenoma, or fungal infection. The patient underwent a bifrontal craniotomy for tumor excision. Postoperative complications can include issues like CSF leak, hemorrhage, or deficits in motor function or vision. Long-term outcomes depend on factors like the tumor grade, extent of resection, and use of radiation therapy
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- 1. MENINGIOMA DR.MUMTAZ ALI NAREJO CONSULTANT NEUROSPINE & CEREBROVASCULAR SURGEON
- 2. OUTLINES • Main features • Common location • Investigations • Types • Sindou et All • Surgical principles • Simpson grading • Histopathological grading • Recurrence rate • Radiotherapy
- 3. Main Features • Most common primary intracranial tumors • Extra-axial • F:M = 1.8:1 • Mean age : 45 years • usually slow growing • circumscribed (non-infiltrating) • benign lesions • arachnoid cap cells (meningothelial cells) • Ectopic meningiomas • Psammoma bodies
- 5. INVESTIGATIONS • XRAY SKULL Calcification • CT SCAN Calcification Hyperstosis • MRI • T1WI: Iso • T2WI : Hypo or iso CSF cleft sign • Contrast : Intense enhancement Broad base Dural Tail • Angiography Feeders
- 7. TYPES ; SPHENOID WING • lateral sphenoid wing (or pterional): • Middle third (or alar) • Medial (clinoidal): ICA MCA cranial nerves optic nerve compress brainstem Total removal is often not possible Pterional craniotomy
- 8. PARASAGITTAL MENINGIOMA • 50% invade SSS • anterior : 33% H/A and mental status • Middle : 50% Jacksonian seizure progressive monoplegia contralateral foot drop • Posterior: 20% H/A, visual symptoms focal seizures mental status changes Parietal craniotomy
- 9. SINDOU ET ALL GRADING
- 10. OLFACTORY GROOVE MENINGIOMA • Foster Kennedy syndrome Anosmia ipsilateral optic atrophy contralateral papilledema • Mental status changes • frontal lobe findings Apathy & Abulia • urinary incontinence • optic apparatus visual impairment • fornix short-term memory loss • seizure • Bifrontal craniotomy • Subfrontal Approach
- 11. PLANUM SPHENOIDALE & TUBERCUM SELLA MENINGIOMA
- 12. FORAMEN MAGNUM MENINGIOMA • Anterior : 31% • Lateral : 56% • Posterior : 13%
- 13. CONVEXITY MENINGIOMA • Pre-coronal • Coronal • Post-coronal
- 17. SURGERY : PRINCIPLE • Preoperative embolization • Autologous blood donation • Early interruption of the blood supply • Internal decompression • Dissection of the tumor capsule • Removal of attached bone & dura
- 18. SIMPSON GRADING
- 20. RADIOTHERAPY • RECURRENCE RATE : 5–15 years • total resection : 4 % • partial resection without XRT : 60% • partial resection with XRT : 32%
- 21. THANKYOU