Meningiomas

Clinical manifestations
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By Wendy Sherman and Jeffrey Raizer

The clinical symptoms of a meningioma are determined by its anatomic site (see Table 1). Meningiomas are extra-axial and occur where arachnoid cells are most numerous, especially within the arachnoid villi along the dural venous sinuses (Campbell et al 2009). Eighty-five percent to 90% of meningiomas are located supratentorially. The most common locations include convexity, sphenoid ridge, and planum sphenoidale (Campbell et al 2009). Meningiomas are rare in children and, when they occur, are more often aggressive and located either in the posterior fossa or intraventricularly. The most common presenting symptoms of meningiomas are headache (36%), change in mental status (21%), and paresis (22%). The most common signs are paresis (33%), normal examination (27%), and memory impairment (16.5%). The site-specific symptoms are of much greater significance and are shown in Table 1.

Table 1. Location of Meningioma and Site-Specific Symptoms

Tumor location

Relative incidence (%)

 

Site-specific symptoms

Convexity

34.7

Headaches, seizures, motor and sensory deficits

 

Parasagittal

22.3

Anterior: chronic headaches, memory and behavior changes

Middle: motor and sensory deficits

Posterior: homonymous hemianopsia

All: venous occlusion

 

Sphenoid ridge

17.1

Medial: visual loss, cranial nerve III, IV, V1, VI palsies

Lateral: headaches, seizures, motor and sensory deficits

 

Lateral ventricle

5.2

Headaches, seizures, hydrocephalus

 

Tentorium

3.6

Ataxia, headaches, visual loss, diplopia

 

Cerebellar convexity

4.7

Headaches, ataxia, dizziness, facial pain, dysarthria

 

Tuberculum-sellae

3.6

Visual loss, headaches, optic atrophy, noncongruent homonymous hemianopsia

 

Optic nerve sheath

2.1

Visual loss

 

Cerebello-pontine angle

2.1

Hearing loss, headaches, ataxia, dizziness, tinnitus, facial palsy

 

Olfactory groove

3.1

Anosmia, Foster Kennedy syndrome, headaches

 

Foramen magnum

0.52

Nuchal and occipital pain, emesis, ataxia, dysphagia, motor and sensory deficits

 

Clivus

0.5

Headaches, emesis, ataxia, motor and sensory deficits

 

Other

0.5

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Parasagittal meningiomas occur anywhere along the anterior or posterior course of the falx, with symptoms dependent on the location. Anterior parasagittal tumors produce headaches, memory loss, and personality changes. Tumors located in the middle of the falx produce motor and sensory deficit, and those located posteriorly produce homonymous hemianopsia. Anterior tumors may obstruct cerebrospinal fluid outflow at the foramen of Monro, and obstruction of the sagittal sinus by posterior tumors can produce a sagittal sinus syndrome. The symptoms of sphenoid ridge meningiomas depend on the medial to lateral location along the sphenoid ridge. The medial tumors originate from near the anterior clinoid process, with early unilateral visual loss. They invade the cavernous sinus, with attendant cranial nerve deficits. The lateral tumors displace the frontal and temporal lobes while growing in the Sylvian fissure, and produce headache, seizures, and motor and speech deficits.

In a large study series, malignant meningiomas were located exclusively in the convexity, parasagittal, or tuberculum sellae locations (Rohringer et al 1989).

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Pathogenesis and pathophysiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
Pregnancy
Anesthesia
References cited
Contributors