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Background: Osseous spinal metastases from intracranial meningiomas are rare but represent a serious disease progression. A literature review was performed on this topic to understand the clinical course of patients with this disease entity. We also present a case of spinal metastasis in a patient with a World Health Organization grade III meningioma., Methods: The PubMed/MEDLINE database was queried on August 15, 2021, using the keywords (meningioma) AND (metastasis) AND (vertebra∗ OR spin∗). All publications reporting outcomes of patients with meningioma metastatic to the spine were included. Disease characteristics, treatment modality, and outcomes were extracted from each study. Because data availability varied widely between studies, no meta-analysis was performed., Results: A total of 30 articles with 33 cases were included. Outcome data varied greatly in terms of quality and length of follow-up. Of 28 cases with reported outcomes data, 20 resulted in patient mortality ranging from a few weeks to 5 years after spinal metastasis. Mean (standard deviation) survival time was 5.8 (6.4) years following initial diagnosis, but only 1.4 (3.2) years from spinal metastasis. The longest survivor was noted to have no recurrence of disease 4 years after spinal metastasis., Conclusions: Bony spinal metastasis from intracranial meningioma is an extremely rare occurrence. Within the limits of the available literature, outcomes of patients with this disease appear to be poor. However, data reporting is inconsistent, and several articles did not report any outcome data. Further study is needed to better clarify the course and prognosis of this disease., (Copyright © 2023. Published by Elsevier Inc.)

Background: Malignant meningiomas are rare neoplasms of the central nervous system that occur de novo or rarely as a result of transformation. They have a higher rate of recurrence and metastasis accompanied by a significantly shorter survivorship compared with benign variants. Meningioma cancer stem cells (CSCs) have been previously shown to be associated with resistance and aggressiveness. However, the role they play in meningioma progression is still being investigated., Case Description: We report a 29-year-old man who underwent a resection of a grade I meningioma in 2011. The patient had multiple local recurrences of the tumor that showed an aggressive change in behavior and transformation to grade III meningioma, and developed extracranial metastasis to the cervical spine. He underwent multiple operations and received radiotherapy. Analysis of the tissues indicated the presence of CSC markers before metastasis, and showed increased expressions of associated markers in the metastasized tissue. In addition, similar to the patient's profile, the pharmacological testing of a primary cell line retrieved from the metastasized tissues showed a high level of drug tolerance and a diminished ability to initiate apoptosis., Conclusions: Malignant progression of grade I meningioma can occur, and its eventuality may be anticipated by detecting CSCs. We performed a comprehensive literature review of relevant cases and discussed the clinical, diagnostic, and management characteristics of the reported cases., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Meningiomas represent the most common tumours of the central nervous system in adults. Risk factors include ionizing radiation, female hormones exposure, head trauma, cell phone use, breast cancer and family history of meningioma. Despite complete surgical resection, natural history of meningiomas often includes local recurrence but very few metastatic meningiomas have been reported. Here, we report the case of a metastatic meningioma. A 43-year-old woman was firstly treated for a symptomatic parietal meningioma WHO grade II by surgical resection followed by an irradiation of the surgical bed. After surgical resection and irradiation, the patient recovered incompletely. Two months after the end of the radiation treatment, the patient presented at the emergency unit for sciatic pain revealing bone metastases that has been histologically confirmed. Moreover, imaging led to the diagnosis of liver and lungs metastasis. Despite lack of guidelines for metastatic meningioma, few treatments have been used and published for recurrent and multiple meningioma management. In case studies, some partial responses have been seen with mifepristone and improved progression-free survival rates have been obtained with hydroxyurea and sunitinib. Metastasis in meningioma is very uncommon and no specific management has been described. Hydroxyurea, sunitinib and mifepristone could be options if no clinical trial data is available., (Copyright © 2017. Published by Elsevier SAS.)

We report a patient with intraspinal rhabdoid meningioma that recurred and metastasized to the liver despite surgery and radiation therapy. Rhabdoid meningiomas have characteristic histological features. The positive immunostaining of tumour cells for vimentin and epithelial membrane antigen may aid in the diagnosis of this rare tumour., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Study Design: Case report., Objective: To report a case and review the literature on intracranial malignant meningioma with metastasis to the spine., Summary of Background Data: Because so few cases have been recognized and reported, the radiologic and pathologic assessment, pathway of metastasis, and the concepts of surgical resection and other palliative management of this disease are still controversial., Methods: A big lobulated mass in the left frontal lobe containing calcifications and tumor bleeding was resected. Pathologic findings indicated malignant meningioma due to bone destruction and dura invasion grossly, and tumor cellular atypism with mitotic activity and massive tumor necrosis microscopically. Radiotherapy followed, and brain computed tomography revealed no definite evidence of recurrence. Three months later, spinal magnetic resonance imaging revealed multiple bone metastasis in lower T-L-S1, and pathologic fracture of L1 with compression of the dural sac and spinal cord. Surgical resection was done for decompression, fixation, and pathologic proof., Results: Both pathologic and immunohistochemical survey found evidence consistent with malignant meningioma with spinal metastasis. Advanced treatment was refused, and the patient died., Conclusion: Spinal magnetic resonance imaging should be performed because of the high spinal metastatic rate, especially when spinal symptoms and signs are present. Immunohistochemical study has an important role in the differential diagnosis of primary or metastatic intracranial neoplasms.

Purpose: The purpose of this study was to characterize the 2-deoxy-2-[18F]fluoro-D-glucose (FDG) PET/CT imaging findings of sacral metastatic meningioma., Materials and Methods: An 18-year-old woman with a history of metastatic meningioma, who presented with intractable pain and spasm of the right lower extremity, underwent FDG PET/CT imaging., Results: FDG PET/CT scan demonstrated a moderately hypermetabolic sacral mass. The biopsy of the lesion was consistent with a high-grade malignant meningioma., Conclusions: Although meningioma is typically a benign tumor, in rare instances, it metastasizes. The current case example exhibits moderately increased metabolism despite findings of high-grade malignancy on biopsy.

Study Design: This report describes a 51-year-old woman with a sacral metastatic meningioma that originated from an intracranial meningioma., Objectives: To describe an unusual presentation of a metastatic meningioma in the sacrum., Summary of Background Data: Extracranial metastases of meningioma are very rare. The phenomenon of metastasis may have more to do with the ability to invade the wall of a blood vessel than with the mitotic activity of a tumor. Therefore, metastases of the meningioma can occur even with a benign histologic picture in the original intracranial meningioma., Methods: A 51-year-old woman had experienced low back pain and sciatica of the left leg for several months. Plain radiographs of the lumbosacral spine showed an osteolytic lesion with an irregular margin that occupied the left side of the sacrum. Magnetic resonance imaging revealed a soft mass invading the left sacrum, ilium, and presacral space., Results: Surgical removal of the sacral tumor via an anterior-posterior-anterior approach was done. Histopathologic examination revealed a metastatic meningioma with a meningotheliomatous histologic composition. Sixteen months after excision of the metastatic sacral lesion, the patient was ambulating freely and experiencing mild constipation and urine retention., Conclusions: In this case of metastatic meningioma in the sacrum, which is the first such report to the authors' best knowledge, total excision of the tumor was successful.

This report describes a case of metastatic meningioma involving the first thoracic vertebral body in a 63-year-old woman. The patient was treated surgically 10 years earlier for a benign meningioma of the right parietal vault. Local recurrence was diagnosed in 1992. Despite the gamma-knife radiosurgery, recurrence required surgical treatment in 1999. Histological findings were compatible with atypical meningioma (grade II WHO). One year later, the patient presented left C8 cervicobrachial neuralgia. Investigation led to discovery of a D1 tumor that was a metastasis of the atypical intracranial meningioma. A resection of the vertebral T1 body with C7-T2 osteosynthesis was performed with an excellent recovery and no postoperative complication.

We report a case of a 31 year-old woman who in 1991 presented a clinical history of headaches, nausea and vomiting. CT scan showed a right frontotemporal meningioma. The first operation achieved a macroscopically complete resection. The tumour was histologically classified as a transitional meningioma. There were recurrences of the intracranial meningioma in 1994, 1996, 1997 and 1998. These recurrences were accompanied by differentiation to atypical and anaplastic meningioma. In all of these operations, a macroscopically complete resection of the tumour was performed. In 1996 adjuvant radiation therapy was given. In 1998 therapy with bromocriptine was adopted. In April 1999, the patient presented with lumbosacral pain associated with L5 bilateral sciatica. MRI showed a gadolinium enhancing mass lesion at L5-S1 level. Complete tumour resection was performed. The histological findings were the same as in 1998. In December 1999 the patient presented with perineal pain and MRI showed a L4 and S3 recurrence and the tumour was resected. The histological findings were those of a malignant meningioma. In February 2000 an intracranial recurrence was detected and operated on. The histological diagnosis was malignant meningioma. A review of the literature was undertake and is discussed.

Clear-cell meningiomas have a more aggressive behavior than other meningioma subtypes and the cytologic features of clear-cell meningioma have not been described. A fine-needle aspiration biopsy (FNAB) of a sacral clear-cell meningioma was performed in a 28-yr-old woman. This tumor was a metastasis from a posterior fossa meningioma that had been unresectable, but had been present for 7 yr. Cytologically, clear-cell meningiomas have a whorled, syncytial architecture and spindled to polygonal, bland-appearing nuclei. In contrast to the more classic meningioma, the clear-cell variety has vacuolated cytoplasm. The differential diagnosis includes a number of other neoplastic processes. Separation of clear-cell meningioma from these other entities may be difficult because of its rather unusual cytoplasmic features and its occurrence in unusual sites.

Meningioma is a neoplastic growth originating from the leptomeninges. Although meningiomas are usually benign, malignant meningiomas with distant metastases occur infrequently. There is little precise information in the literature regarding the frequency of metastases in meningiomas; their incidence has been vaguely reported to be less than 1 per 1,000. Furthermore, most of the previous studies have also included haemangiopericytomas which most recent authorities do not consider meningiomas. In our experience with the management of 396 meningiomas over the past 18 years, 7 meningiomas were classified as malignant by defined histological criteria. After initially presenting as solitary intracranial neoplasms, three of the malignant meningiomas metastasized to extracranial tissues. Collectively, the metastases involved the vertebral bodies, liver, pelvis, long bones, and the spinal cord. This confers an incidence of metastasis of 0.76% when considering all the meningiomas, and an incidence of approximately 43% when considering only malignant meningioma; both percentages are significantly higher than reported previously. This high incidence of metastasis in the malignant meningioma indicates a worse prognosis than formerly assessed and also characterized the malignant meningioma as a primary central nervous system neoplasm with one of the highest rates of metastasis. In addition, when malignant meningioma is classified by following strict criteria, the risk of metastasis in the ensuing clinical course can be predicted with a higher reliability.

A rare case of C2 vertebral body metastasis from a parasagittal meningioma is reported. The metastatic lesion was found 13 years after resection of the primary lesion. The primary and the metastatic lesions had a similar and benign histological appearance. Remote metastasis of a meningioma can occur even with a benign histological finding after a variable disease-free period.

A biopsy of a fifth lumbar vertebral lesion confirmed that an intracranial meningioma had metastasized 12 years after the diagnosis of the primary tumour. A literature review reports 25 cases of extracranial osseous metastases from meningioma. The mechanisms of spread are discussed as is the role of surgery in the seeding of such tumours.

A series of 256 consecutive patients suffering from spinal tumours was studied with respect to the value of bilateral or unilateral surgical approaches. The case material included 152 extradural, 87 intradural, extramedullary and 17 intramedullary tumours. The cervical spinal cord was involved in 43, the thoracic in 152 and the lumbosacral region in 61 cases. Hemilaminectomy was chosen mainly for juxtamedullary tumours, while laminectomy was used for intramedullary tumours. No remarkable difference regarding the choice of approaches was found in extradural tumours. More than 60% of cervical or lumbosacral tumours were managed using unilateral procedures. A higher rate of surgical radicality but fewer complications, shorter stay in hospital and better early results were achieved using hemilaminectomy especially in patients with juxtamedullary tumours. From the observations it may be concluded that the results do not depend on the type of surgical approach but are closely related to the histology and location of tumours. Under the prerequisite of exact pre-operative definition of tumour location, unilateral approaches are advantageous for all kinds of spinal tumours especially for juxtamedullary benign tumours.

A very unusual case of metastatic spread of a meningioma is described. The clinical presentation was of extradural spinal cord compression, without evidence of a primary tumor. Computed tomography did not reveal any intracranial meningioma; the histopathology of the extradural spinal tumor was identical with that of two intracranial meningiomas previously excised.

We report case of malignant meningioma involving the lumbar vertebra (3rd and 4th). A 53-year-old man who developed occipitalgia in April 1977 was operated under the diagnosis of posterior fossa tumor in August 1977. The tumor was totally removed macroscopically Simpson grade 2. The histological diagnosis was malignant meningioma, He complained of lumbago and right leg pain since June 1981. Destruction and tumor stain of the 3rd and 4th lumbar vertebrae were recognized on CT scans. In May 1982, surgical decompression and spinal fixation were attempted. The surgical specimen was verified as a malignant meningioma. Therefore, he underwent irradiation therapy to the lumbar spine (total dose 50 Gray). He presented with occipitalgia in March 1983. CT scan detected tumor recurrence in the suboccipital region. The recurrent tumor was totally removed immediately. The histological feature was malignant meningioma. The mode and site of metastasizing meningioma are discussed with a review of the literature.