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The paper presents a case of a Jehovah's Witness, 64-year-old woman harboring multiple meningiomas in the right cerebral hemisphere. As the first stage of her treatment endovascular embolization of the tumor vascular bed was performed. Through the middle cerebral artery Ivalon particles and acrylic glue were injected. Four days later the patient underwent craniotomy and four intracranial meningiomas were removed. Intraoperative blood loss was minimal and the patient was discharged with no neurological sequelae and without anemia. The authors emphasize benefits that endovascular embolization may bring, especially as regards improvement of neurosurgical treatment safety in Jehovah's Witnesses.

This article describes an innovative approach to the excision of extramedullary meningioma located in the vicinity of the cranio-cervical junction, a tumour very rarely encountered in clinical practice. The primary innovation consists in the use of the lateral approach, with the addition of partial resection of the lateral mass of Cl. The authors present the case of a patient with a meningioma located at the level of the dens of the epistropheus, on the anterior surface of the spinal cord. The lateral approach used in this case allowed for complete resection of the tumour with minimum operative risk, and the patient's recovery has been excellent.

Meningioma with cystic component is not a commonly encountered tumor. We report three patients with cystic meningioma histologically confirmed. Tomographic images of these tumours resembled those of a glial or metastatic origin with cystic or necrotic changes and were easily confused. In a 2-year period (1997-1999) in our Department we had three patients with cystic meningioma who account for 5.4% of all patients with meningiomas we have.

Steroid receptors play an important role in homeostasis and in proliferation of neoplastic cells as well. Biological effect of steroid hormone on tissues depends on intracellular concentration of its receptor. The binding hormone with its receptor activates adequate genes in cellular nuclei and cell proliferation. The mutation of genes codifying of receptor protein may cause its structural modification or changes in its activity and lead to neoplastic transformation. The aim of our work was the estimation of progesterone receptors (PR) concentration in cerebral neoplasma and correlation with histopathological type and grade of malignancy of cerebral tumours. We examined 89 patients, among them 28 with meningioma, 43 with glioma and 18 with metastatic tumour. The concentration of PR was evaluated using radioreceptor assay. Our results show statistically significant correlation between expression of PR and type and malignancy of neoplastic tumours. It was especially seen in meningioma and the highest concentration of PR were in I grade tumours.

Epidermal growth factor (EGF) influences the cell by activation of its specific cell receptor (EGFR). It is regarded as one of the most effective mitogenic factors and plays a role in carcinogenesis. The aim of this study was the assessment of EGF expression in different types of cerebral neoplasms and searching for its correlation with histopathologic features of malignancy and presence of peritumoral oedema. Sixty seven samples of brain tumours were examined. Among them were 17 meningiomas, 34 gliomas and 16 metastases. Expression of EGF was estimated by a radioimmune assay. The authors found the presence of EGF in all types of tumours. No correlation was found between expression of EGF and histopathological signs of tumour malignancy, although a tendency appeared towards a higher level of that factor in anaplastic tumours. Also, no correlation was found between EGF and peritumoral oedema.

The aetiology of peritumoral brain oedema still remains unclear, despite investigations, attempted to study the role of various clinical factors and histological features of the tumour. The aim of this investigation was to the evaluate correlation of peritumoral brain oedema with expression of progesterone (PR) and oestrogen (ER) receptors and vascular--endothelial growth factor (VEGF). Eighty nine samples of brain tumours were examined, among them 28 meningiomas, 43 gliomas and 18 metastatic tumours. Expression of steroid receptors was examined with the radioreceptor assay method and expression of VEGF by radioimmune assay. A statistically highly significant correlation was found of VEGF expression with the incidence of diffuse pattern of brain oedema around gliomas and metastatic tumours (p < 0.01). PR expression was associated significantly with the occurrence of localized type of oedema around meningiomas, but in gliomas the expression of this receptor correlated with a diffuse pattern of oedema. No correlation was found between ER expression and peritumoral brain oedema.

Differential diagnosis between the intracranial complications of paranasal sinusitis and cerebral tumor belongs to very difficult tasks in otolaryngology and neurosurgery. Complications of sinusitis, such as intracranial abscess formation, are uncommon and often clinically unremarkable. The arising difficulties are even greater in inflammatory intracranial complications of sinusitis, giving symptoms similar to those of cerebral tumors. The illustrative case report was presented.

A case of a 91-years old woman is presented. She had multiple intracranial meningiomas, and the only symptom was the chronic headache. The diagnosis was made on the base of CT scan. The patient finally died. Postmortem examination confirmed the diagnosis.

A rare case of cystic meningioma of the right cerebral hemisphere is presented. The additional factor, which was making difficult the proper diagnosis, was the long period of involuntary movements due to the existing tumour.

The authors present some clinical aspects of their own experience in the operative treatment of clinoidal and en-plaque suprasellar meningiomas which account for 5.6% of all intracranial meningiomas in Department of Neurosurgery treated in the years 1987-93. Visual loss was the first symptom of disease. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. Possibilities of total removal are limited by the size of tumour and compression of adjacent structures, and the chance for visual improvement is low for that reasons. Visual improvement was observed in only one case after surgery, however in 5 cases worsening of visual acuity was noted in postoperative period. Mortality rate was 6.2%. Adjuvant radiotherapy was performed in non patient. Long term results in ophthalmological and neurological aspects are discussed.

The histological structure of meningiomas as well as symptomatology, diagnostics and treatment of those tumors originally localized in the temporal bone is discussed on the basis of literature. A case of a histologically confirmed intratympanic meningioma in a 43-year-old woman is presented. The original symptoms of the tumor imitated the symptoms of the chronic otitis media. Two operations of the ear were performed and the tumor which was completely removed has not given any symptoms of metastasis for six years.

The authors present their own experience in the treatment of tuberculum sellae meningiomas. The presented series includes 14 patients operated on during past 7 years. Visual loss was the first symptom in 78% of patients. The period between the onset of symptom and surgical treatment was long and in the majority of patients exceeded 2 years. Monocular blindness was found in 71% of cases prior to surgery. The authors present the results of surgical treatment with special attention directed to visual function after surgery. In conclusion, the authors stress the still unacceptably long period between the onset of symptoms and correct diagnosis. When the size of tumour exceeds 4 cm and compressing of adjacent important neurovascular structures is evident, possibilities of total removal are limited and the chance for visual improvement is low.

Purpose: To analyse the results of surgical treatment of tumors located in the posterior part of the orbit., Material and Methods: 12 patients (5 women and 7 men, aged 10-70 years) with tumors located in the posterior part of the orbit, operated on in the years 1985-1995 in Ophtalmology Clinic in Bialystok with the use of Krönlein-Berke-Reese lateral orbitotomy method. Tissues of removed tumor were evaluated histopathologically., Results: In 7 cases tumor was removed completely, including 3 cases with simultaneous optic nerve removal. In 3 other cases tumor was removed partially, whereas in 2 cases eventration of the orbit was necessary. Persistent postsurgical defects of the eyeball mobility were not found in any of the patients. In 2 patients with partially removed tumor a constant blepharoptosis was observed, which required further operation. Visual acuity in patients with preserved optic nerve remained unchanged in 6 out of 7 cases. In 1 case-completely removed cavernoma-visual acuity decreased from 5/7 to 5/16., Conclusions: Lateral orbitotomy enables successful removal of tumors located in the posterior part of the orbit. Moreover, this method is relatively safe, especially in comparison with cranial approach to tumors badly located in the orbit.

Primary meningioma of the orbit is very rare. A radical surgical treatment of primary meningioma of the orbit by a thirteen years old boy was carried out. Main symptoms communicated by the patient were amblyopia, which terminated in blindness, as well as increasing exophtalmos of a bulbus oculi. After the operation a regression of exophtalmos has been achieved while the blindness stayed unchanged.

A case is described of intracranial meningioma development in a woman aged 69 who had craniotomy 28 years earlier. The meningioma grew at the site of previous craniotomy. Documented cases from the literature are quoted in which craniocerebral trauma was unequivocally related to meningioma development, although the coincidence of trauma with meningioma is still controversial.

Fifty-three-year-old woman was admitted to hospital with tetraplegia symptoms and died two hours later. Clinical diagnosis was: cerebral stroke, hypertension in anamnesis. Postmortem examination showed ruptured dissecting aneurysm of thoracic and abdominal segment of aorta, meningioma of right pontocerebellar angle and saccular aneurysm of left inferior, posterior cerebellar artery. The diagnostic difficulties and hypotheses of formation of multifocal of different changes are discussed.

A sporadic case of neurofibromatosis type 2 in a 23-year old woman is described with clinical and neuroimaging (CT or MRI) 4 years follow-up. Together with bilateral acoustic tumours multiple intracranial tumours and solitary orbital meningioma were present, the latter being confirmed surgically and histopathologically. Ocular findings of congenital cataract but lack of other external stigmata of neurofibromatosis completed the clinical picture of the disease. Diagnostic criteria of NF2, difficulties in establishing the optimal management options are described and the importance of evaluating of family members is underlined. Neuroimaging pictures showed tumour expansion over 4 years leading to severe disability with total blindness, deafness, paresis and cerebellar syndrome.

The incidence of various histological subtypes of intracranial meningiomas and recurrences was examined in 565 patients with surgically treated meningiomas in the Department of Neurosurgery in Poznań, between 1960-1992. Approximately 60% of the tumours were located on the convexity (39.5%) and parasagitally (23%). Histological diagnosis in 88% of the patients was endotheliomatous (61%), fibroblastic (17%) and angiomatous (10%) meningiomas. The incidence of recurrence after complete removal of the meningioma was 7% for all sites, but much higher after partial removal. Among the recurrences, there was a higher degree of malignant and angiomatous subtypes. Surgery is the accepted form of treatment for meningiomas but it may prove insufficient as the only method of therapy in certain situations. Implications for the potential role of postoperative radiation therapy are discussed.

A rare coexistence of multiple intracranial neoplasms of mesodermal origin with asymptomatic syringomyelia is reported. The clinical findings were documented by NMR and CT results. The histological examination of the tumours removed surgically is included.

A case of a 58-year old woman in whom two meningiomas were discovered and removed successfully is presented. One of the meningiomas belonged to tentorial meningioma and was localized in the posterior fossa, compressing the right cerebellar hemisphere and fourth ventricle and finally producing obstructive hydrocephalus. The second was parasagittal meningioma and was localized in the frontal region on the left side. The patient was operated in two stages--first ventricular drainage was applied and posterior fossa meningioma was successfully removed totally with coagulation of the dural attachment. In the second stage, one month after the first operation parasagittal meningioma was removed totally, dural attachment was thoroughly coagulated. The patient had a good outcome is self dependent and able to carry on normal activity.

Fifty-one cases of parasagittal meningiomas were analysed. In 37 cases the tumour was situated in the middle and posterior part of the falx. In 17 cases occlusion of the superior sagittal sinus was diagnosed and confirmed by angiography. No correlation was found between the extent of brain oedema and sinus occlusion and tumour size. However, extensive oedema was present in tumours of high malignancy. Occlusion of the sagittal sinus caused no increase of intracranial pressure or venous stasis. This suggests that sinus occlusion caused by meningioma is completely compensated and has no effect on the preoperative and postoperative course.

The authors provide brief clinical data and cytologic description of two extracranial meningiomas presenting as a cervical mass. Regardless of the rarity of the meningiomas in the neck region, using morphological criteria described in this article it is possible to diagnose preoperatively such a tumor by aspiration cytology.

A clinical description and pathological findings are reported in a case of extrameningeal, angiogenic malignant meningioma of the vertebral canal (Th7-Th11) in a patient aged 17 years. Clinical picture was that of transverse myelitis at the Th9 level, with spastic paraparesis, funicular loss of all sensory functions and sphincter disturbances. The authors suppose that the used combined treatment (chemotherapy and radiotherapy, surgery) improved greatly the health state inhibiting the spread of metastases and prolonged survival to 3 years. Autopsy demonstrated recurrence of he tumour in the vertebral canal and numerous metastases to the brain, lungs, liver, bones and pancreas.

The authors present a case of a 47 year-old woman admitted to Neurosurgical Clinic with diagnosis of left frontal lobe tumour. At operation, during removal of glioma of the frontal lobe, a parasagital meningioma, 3 cm in diameter, was found and removed. Both tumours were adjacent. Histopatologic examination revealed: grade 1 astrocytoma and fibroblastic meningioma. Some clinical and pathological problems associated with simultaneous occurrence of two tumours of various histologic origin are discussed.

The authors report a case of primary malignant meningioma of meninges in the right frontal area with metastases to meninges in the right temporal area and left atrial endocardium and with emboli composed of malignant cells in the vessels of the myocardium, spleen, liver, lungs and pancreas in a 49-year-old woman after commissurotomy performed for rheumatic valvular heart disease.