Jornal de Coluna e Neurocirurgia

Distant Multifocal Bony Metastasis of a Grade II Meningioma: Case Report

AHalani SH, Appin C, Brat DJ and Hadjipanayis CG

Introduction Meningioma is the most frequent neoplasm of the central nervous system, accounting for nearly one-third of all intracranial tumors. The vast majority are benign and cured by surgical resection. Grade II meningiomas may show local invasion involving the brain, intracranial venous channels, bones, soft tissue and paranasal sinuses. Distant metastasis, on the other hand, is quite rare. Case Presentation We report distant, multifocal bony metastasis of an atypical meningioma, World Health Organization grade II, from a primary occipital lobe location in a patient who initially underwent stereotactic radiosurgery followed by surgical resection 4 years prior. The patient presented clinically with pain in the lower back and gluteal region. Distant metastases were noted radiologically in the lumbar spine, pelvis, and femur and were confirmed pathologically following biopsy. Conclusion Metastasis from meningiomas is exceedingly uncommon. In the present case, hematogenous spread to the lumbar spine, pelvis, and femur may have occurred due to a residual nodular remnant within the superior sagittal sinus.