Presentation
History of seizures. Now presenting with multiple breakthrough seizures despite adherence to prescribed medication.
Patient Data
There is a left frontal extra-axial mass that demonstrates fairly homogeneous enhancement with associated effusion, suggesting hypercellularity. There are numerous serpentine flow voids along the superior and posterior margins of the of the mass which likely originate from the left greater than right anterior cerebral arteries. There is a large region of hyperintense T2/FLAIR signal in the left corona radiata and centrum semiovale, which likely represents cerebral edema. There is a midline shift and rightward displacement of the interhemispheric fissure. There is regional mass effect with compression of the bilateral lateral ventricles and anterior aspect of the third ventricle. There is mild mass effect on the cerebral peduncles and posterior displacement of the anterior body of the corpus callosum. There is encephalomalacia/gliosis in the left frontal and temporal lobes.
Case Discussion
This is a large meningioma in a pediatric patient.
She underwent resection which removed approximately 85% of the mass. Histopathology was consistent with a WHO grade 1 meningioma with hypercellularity and minute focal necrosis. No frank anaplasia or cerebral invasion were noted. Post-op imaging revealed stable residual disease with no growth or hemorrhage.
Significant growth was noted on a surveillance study 8 months after the previous resection. She underwent another resection, which again demonstrated pathology consistent with a WHO grade 1 meningioma. Additionally, the patient received proton therapy to the meningioma. Follow-up imaging has showed slow, but progressive growth.
Co-author:
Jun Yang
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