Multiple meningiomatosis

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Multiple meningiomas or meningiomatosis are defined by the presence of at least 2 lesions that appear simultaneously or not, at different intracranial locations. Early classification of Cushing and Eisenhardt claimed that a diagnosis of multiple meningioma can only be made if the patient does not suffer neurofibromatosis type I (NF1 is associated with neurofibromin, ras pathway). Majority of multiple meningiomas associate with neurofibromatosis type-II, multiple meningiomatosis refers to the association of at least 2 tumors in two different sites, in a patient who has no evidence of neurofibromatosis. The incidence of this condition varies between series between 1 and 3%, reaching a frequency of 8% with the onset of magnetic resonance imaging (MRI). This entity combines benign tumors of a different histological nature in 30% of cases. A 39-year-old woman patient, with no significant pathological history, who consulted for heaviness in both lower limbs having progressed for 6 months with paresthesias without genitosphincteric disorders, the examination found a spastic paraparesis rated at 3/5. The patient underwent a medullary MRI which revealed 4 lesions, the radiological semiology of which was suggestive of spinal meningiomas, the most compressive projecting in relation to T2. A cerebral computed tomography (CT) was systematically performed and objectified two intra cranial meningiomas, which until then were asymptomatic. Although its incidence is only 1 to 3%, the discovery of multiple meningiomatosis justifies morphological exploration (MRI) of the entire neurax, in which case any symptomatic location should suggest surgical management.

Figure 1.

(A,B) brain MRI with contrast axial section showing frontal convexity meningioma, spine MRI on sagittal sections on T1 injection showing 4 lesions, the most compressive meningiomas are projected in T2 whose major axis is 28 mm