Meningioma presentation by dr,Mumtaz Ali narejo

Meningioma is described in detail its origin , type , presentation and management

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 M ost 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

4. COMMON LOCATIONS

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

6. INVESTIGATIONS

7. TYPES ; SPHENOID WING lateral sphenoid wing (or pterional ): M iddle third (or alar) M edial ( 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 M ental 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

14. PETROCLIVAL MENINGIOMA

15. INTRAVENTRICULAR MENINGIOMA

16. CP ANGLE MENINGIOMA

17. SURGERY : PRINCIPLE Preoperative embolization A utologous blood donation E arly interruption of the blood supply I nternal decompression D issection of the tumor capsule Removal of attached bone & dura

18. SIMPSON GRADING

19. HISTOPATHOLOGICAL GRADING

20. RADIOTHERAPY RECURRENCE RATE : 5–15 years total resection : 4 % partial resection without XRT : 60% partial resection with XRT : 32%

21. THANKYOU