Multiple meningioma in separate neuraxial compartments

Introduction: Multiple meningioma is a rare condition, defined by Cushing and Eisenhardt as one in which a patient has more than one meningioma, something less than a diffusion of them. Due to the extreme rarity of this entity, we are reporting a case of a 69 years-old woman without clinical or genetic evidence of neurofibromatosis type 1, who developed a right frontal meningioma and 30 years later was found to have a 2nd meningioma in the parieto-occipital area and 3 other lesions in the spinal canal. This case is one of our casuistics just revised of 113 meningiomas over a period of 20 years, since 1976. Case Report: The patient presented with a syndrome of intracranial hypertension, in November 1995. There were no neurological deficits on clinical examination. CT showed a hyperdense tumor in the right parieto-occipital area and the previous craniotomy performed in 1966 for excision of the 1st meningioma. The second tumor, localized in the parieto-occipital area, was operated in December 1995, (grade 1 Simpsonʹs classification). There were no problems during the post-operative period. Two months later the patient came back to the out-patient clinic with sciatica, walking difficulties, weakness of the legs and inversion of the right plantar reflex. MRI of lumbar column showed 3 other tumors at the level of T 9-L1 vertebras. The patient was submitted to a laminectomy. The three tumors were completely removed and by the time of discharge, 8 days later, she was in excellent condition. All tumors were compatible with psammomatous meningioma. Discussion: Multiple meningiomas were rare before CT or MRI, Nowadays, some authors reported a frequency around 20% among patients with meningioma. We found only 2, in the last 10 years. In this paper we discuss the genetic and endocrinological aspects; the probable dissemination pathway; other possibilities of diagnosis and treatment; and present an updated review of this very important pathology.