Overview of Meningioma (Short review of types,symptoms and treatment)

Short review of locational classification and symptoms related to specific meningioma and treatment flowchart of meningioma.

1. Overview of Meningioma Dr. Khan Md. Nazmus Sakib Sr. Rmo , Department of Neurosurgery Asgar Ali Hospital

2. Defination Meningiomas are the most common primary central nervous system (CNS) tumors. They are usually benign, slow growing neoplasms. They originate from arachnoid cap cells. Arachnoid cap cells make up the outer layer of the arachnoid mater and arachnoid villi.

3. Risk Factors Ionizing Radiation Obesity Occupational (Pesticide/Herbicide)/Diet/Allergies Hormone Cytogenetics Familial Syndrome Neurofibromatosis Type 2 (NF2) Gorlin syndrome Cowden syndrome Werner syndrome BAP1 Tumor Predisposition Syndrome Familial Syndromes Associated with SMARCB1 and SMARCE1 Other familial syndrome (Li- Fraumeni , Turcot , Gardener, von Hippel-Lindau, Rubinstein– Taybi syndromeand MEN1)

4. Locational classification of meningioma with associated mutations & frequency Location & associated mutations Frequency Convexity 20-37% Parasagittal ( NF2) 13-22% Spine ( AKT1 ) 7-12% Skull Base Frontobasal ( TRAF7, AKT1, POLR2A, PIK3CA, SMO) Sphenoid and Middle Cranial Fossa ( TRAF7, AKT1, PIK3CA ) Posterior Fossa ( NF2 ) 43-51% Inraventricular (NF2) 1-5% Orbital <1-2% Ectopic Location <1%

5. Skull base and non-skull base meningioma

6. WHO classification of meningioma Grade I (Benign) Grade II (Atypical) Grade III (Malignant or Anaplastic ) Histological Subtypes Meningothelial Fibrous Transitional Psammomatous Angiomatous Microcystic Secretory Lymphoplasmacyte -rich Metaplastic Atypical Clear cell Choroid Anaplastic Rhabdoid Papillary Diagnostic criteria Presence of <4 mitoses per 10 HPF 1.Presence of 4–19 mitoses per 10 HPF or 2.Brain invasion or 3.At least 3/5 of the following : - Patternless sheeting architecture -Small cell formation with high N/C ratio -Prominent nucleoli - Hypercellularity -Spontaneous intratumoral micronecrosis Presence of ≥20 mitoses per 10 HPF or Overtly malignant morphology (carcinomatous, sarcomatous , and melanomatous cytology)

7. Symptoms Headache Seizures Changes in personality or behavior Progressive focal neurological deficit Confusion Drowsiness Hearing loss on ringing in the ears Muscle weakness Nausea or voimting Visual disorders

8. Convexity meningioma : May cause seizures, headaches and neurological deficits.

9. Suprasellar meningioma : Vision problems due to compression of the optic nerves.

10. Falx and Parasagittal meningoma : Impaired levels of brain functioning, such as in reasoning and memory. If located in the middle section, it would likely cause leg weakness/numbness or seizures

11. Olfactory Groove meningioma : Loss of smell due to compression of the nerves that run between the brain and the nose. If the tumor grows large enough, vision problems may occur due to compression of the optic nerve.

12. Posterior Fossa meningioma : Facial symptoms or loss of hearing due to compression of cranial nerves, unsteady gait and problems with coordination.

13. Sphenoid meningioma : Vision problems, loss of sensation in the face or facial numbness and seizures.

14. Intraventricular meningioma : May block the flow of cerebrospinal fluid, resulting in obstructive hydrocephalus, potentially leading to headaches, lightheadedness and changes in mental function.

15. Spinal meningioma : Back pain or pain in the limbs caused by compression of the nerves that run into the spinal cord.

16. Diagnosis CT scan MRI

17. Treatment

18. Treatment

19. Thank you all