Cui Junxiang, Sun Hu, Sun Shuo, Zhao Hao, Gu Yinghao
School of Clinical Medicine, Shandong Second Medical University, Weifang, Shandong, China.
Department of Neurosurgery, Zibo Central Hospital, Zibo, China.
Front Oncol. 2024 Dec 6;14:1506297. doi: 10.3389/fonc.2024.1506297. eCollection 2024.
Meningiomas are some of the most prevalent primary brain tumors in adults, and are typically non-neuroglial in nature. A variety of symptoms may be observed, including headaches, fluctuations in mental status, ataxia, muscle weakness, nausea and vomiting, seizures, visual changes, speech disorders, and sensory abnormalities. The World Health Organization (WHO) has a grading system for meningiomas based on histological criteria, which is as follows: Grade 1 meningiomas are considered benign; Grade 2 meningiomas have a moderately aggressive nature and usually present with histological atypia; and Grade 3 meningiomas exhibit aggressive malignant behavior. Grade 3 meningiomas are distinguished by aberrant and accelerated cellular proliferation, which increases the probability of invasion and recurrence within the central nervous system relative to the other grades. Malignant meningiomas are further classified by tumor size. For example, WHO grade 3 meningiomas with diameter >5 cm are designated giant meningiomas. Giant meningiomas are complicated by their potential for compression of the brain tissue, which can lead to increased intracranial pressure and hemodynamic changes. In many cases, these changes induce vasogenic edema in the adjacent brain tissue. This article details a rare case of rapidly growing atypical giant meningioma that progressed to an anterior-posterior diameter of 13 cm within 3 years, occupying the majority of the left hemisphere of the brain and encroaching upon the right intracranial structures. Through recent advances in medical diagnostics and heightened public awareness of health issues, cases with such large meningiomas have become exceedingly rare. Fortunately, the tumor in the present case was successfully resected using advanced surgical techniques that employed microscopy in conjunction with sodium fluorescein, resulting in complete removal of the tumor and restoration of the patient's muscle strength postoperatively. The value of fluorescence-guided surgery in this type of procedure is support in the present case report.
脑膜瘤是成人中最常见的原发性脑肿瘤之一，其本质上通常不是神经胶质肿瘤。可能会观察到多种症状，包括头痛、精神状态波动、共济失调、肌肉无力、恶心和呕吐、癫痫发作、视力变化、言语障碍和感觉异常。世界卫生组织（WHO）根据组织学标准对脑膜瘤有一个分级系统，如下：1级脑膜瘤被认为是良性的；2级脑膜瘤具有中度侵袭性，通常表现为组织学异型性；3级脑膜瘤表现出侵袭性恶性行为。3级脑膜瘤的特征是细胞异常增殖且加速，相对于其他级别，这增加了中枢神经系统内侵袭和复发的可能性。恶性脑膜瘤还根据肿瘤大小进一步分类。例如，直径>5 cm的WHO 3级脑膜瘤被指定为巨大脑膜瘤。巨大脑膜瘤因其可能压迫脑组织而变得复杂，这可能导致颅内压升高和血流动力学变化。在许多情况下，这些变化会在相邻脑组织中诱发血管源性水肿。本文详细介绍了一例罕见的快速生长的非典型巨大脑膜瘤病例，该肿瘤在3年内前后径发展到13 cm，占据了大脑左半球的大部分并侵犯了右侧颅内结构。随着医学诊断的最新进展以及公众对健康问题的认识提高，如此大的脑膜瘤病例已变得极为罕见。幸运的是，本病例中的肿瘤通过采用显微镜结合荧光素钠的先进手术技术成功切除，术后肿瘤完全切除且患者肌肉力量得以恢复。本病例报告支持了荧光引导手术在这类手术中的价值。
