Toader Corneliu, Brehar Felix Mircea, Radoi Mugurel Petrinel, Serban Matei, Covache-Busuioc Razvan-Adrian, Aljboor Ghaith S, Gorgan Radu M
Department of Neurosurgery "Carol Davila", University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania.
Diagnostics (Basel). 2024 Nov 15;14(22):2566. doi: 10.3390/diagnostics14222566.
This case report highlights a rare presentation of a giant convexity en plaque anaplastic meningioma, located in the left frontoparietal parasagittal region, infiltrating the superior sagittal sinus, and associated with Gerstmann syndrome. This study aims to explore the clinical challenges, surgical management, and potential reversibility of neurological deficits induced by the tumor, including those characteristic of Gerstmann syndrome.
A 76-year-old male patient presented with a history of worsening expressive aphasia and cognitive impairments, culminating in a generalized seizure. Preoperative imaging confirmed a 4 × 6 cm highly vascularized tumor with significant peritumoral edema. The patient underwent near-total resection of the tumor, aiming for a Simpson grade 2 resection, while managing hypervascularity and brain edema. Histological analysis confirmed the diagnosis of anaplastic meningioma (WHO Grade III), showing features such as necrosis, brain invasion, and high mitotic activity.
Post-surgical follow-up demonstrated significant improvement in the patient's neurological deficits, particularly in expressive language and cognitive function, suggesting a potential reversal of Gerstmann syndrome. Postoperative imaging revealed a moderate degree of cerebral collapse and absence of contrast leakage. Two-month follow-up confirmed no recurrence of neurological deficits.
This case emphasizes the complexity of managing giant convexity en plaque anaplastic meningiomas, particularly when associated with Gerstmann syndrome. Surgical resection, despite the challenges posed by tumor size, hypervascularity, and peritumoral edema, can lead to significant neurological recovery, highlighting the potential reversibility of tumor-induced Gerstmann syndrome.
本病例报告重点介绍了一例罕见的巨大凸面平板状间变性脑膜瘤，位于左额顶矢状窦旁区域，侵犯上矢状窦，并伴有格斯特曼综合征。本研究旨在探讨临床挑战、手术治疗以及肿瘤所致神经功能缺损（包括格斯特曼综合征特征性缺损）的潜在可逆性。
一名76岁男性患者，有进行性加重的表达性失语和认知障碍病史，最终发生全身性癫痫发作。术前影像学检查证实有一个4×6 cm的高血管化肿瘤，瘤周水肿明显。患者接受了肿瘤近全切除，目标是达到辛普森2级切除，同时处理高血管化和脑水肿问题。组织学分析确诊为间变性脑膜瘤（世界卫生组织III级），显示出坏死、脑浸润和高有丝分裂活性等特征。
术后随访显示患者神经功能缺损有显著改善，尤其是表达性语言和认知功能，提示格斯特曼综合征可能得到逆转。术后影像学检查显示有中度脑塌陷且无造影剂渗漏。两个月的随访证实神经功能缺损未复发。
本病例强调了处理巨大凸面平板状间变性脑膜瘤的复杂性，尤其是与格斯特曼综合征相关时。尽管肿瘤大小、高血管化和瘤周水肿带来挑战，但手术切除仍可导致显著的神经功能恢复，突出了肿瘤所致格斯特曼综合征的潜在可逆性。
