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Meningioma

Men-in-jeans
Picmonic
A meningioma is a brain tumor that arises from the meninges. It is the most common primary brain tumor in adults. Meningiomas are benign lesions originating from arachnoid villi and can often be seen having a dural attachment on imaging. They can be located anywhere there are meninges but most often, they are found in parasagittal areas. If the tumor significantly compresses on the motor cortex, contralateral leg weakness may be seen. Seizures are another clinical manifestation. Diagnosis is made by visualization of psammoma bodies and calcifications on histology. Increased bone density may be noticed in bone adjacent to the lesion.
10 KEY FACTS
EPIDEMIOLOGY
Most Common Adult Primary Brain Tumor
Man Holding Up (1) Foam-Finger

This tumor is the most common non-malignant, non-glial primary brain tumor. Even so, although the majority are benign, a small subset of these tumors are malignant. They are more common in women and in patients with neurofibromatosis type 2.

PATHOLOGY
Benign
Bunny

90% of meningiomas are benign and are easily resected if they are found to be growing superficially on the dura.

Originate from Arachnoid Villi
Arachnid-spider with Villi curtains

This tumor is thought to arise from arachnoid villi, which are projections of arachnoid tissue that are involved in CSF absorption.

Dural Attachment
Durex-latex Cap

These tumors can arise anywhere along the dura and therefore often have a dural attachment.

Parasagittal
Parachuting into Parasagittal region

These tumors are most commonly found in the parasagittal region, but can also be found in the falx and hemispheres.

CLINICAL MANIFESTATIONS
Contralateral Leg Weakness
Leg Opposite to Parasagittal Region Weak and Wavy

Given their variable location, meningiomas can compress a range of intracranial structures and therefore present with an array of signs & symptoms. Involvement of the parasagittal region can compress the motor cortex and result in contralateral leg weakness.

Seizures
Caesar

Meningiomas may cause seizures as a result of compression on brain tissue resulting in abnormal neuronal excitability. Examples of other focal neurologic signs include unilateral vision loss with compression of the optic tract, or hearing loss with compression of the cerebellopontine angle.

DIAGNOSIS
Psammoma Bodies
Samoans

Histological examination often shows psammoma bodies which are concentric, ring-like patterns of calcification characteristic of meningiomas. The tissue appears in a whorled pattern. Spindle-shaped cells may also be seen.

Calcifications
Calcified-cow

Calcifications or concretions may be seen on histological specimens. CT or MRI imaging typically show a dural-based mass which may contain calcifications.

Increased Bone Density
Up-arrow Bones

Meningiomas can often incite an osteoblastic reaction in the overlying cranial bone resulting in increased bone density. This hyperostosis is not well understood, though theories include a reaction of the bone to the tumor itself, as well as invasion of the bone by the tumor.

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