Resection of Anaplastic Meningioma via Combined Craniofacial Approach

Yosafat Kurniawan Sugiarto, Arwinder Singh, Muhammad Firdaus, Oskar Ady Widarta, Farilaila Rayhani


Introduction: Meningiomas are common and mostly benign intracranial tumors but may show a histological progression to malignancy. The mechanism of malignant transformation remains unclear. Malignant meningiomas usually bear a high recurrence rate and unfavorable prognosis; hence, multiple surgical resections are required for the treatment

Case Presentation: A 41-year-old woman with a prior history of craniotomy at another center six years ago with Meningioma Grade 1 presented to our institution with new neurological symptoms. The magnetic resonance image demonstrated a large frontal base mass that extended to the nasal cavity with diffuse contrast enhancement and extensive surrounding edema. A craniofacial approach combined with a bifrontal approach was performed in multistage tumor resection. The tumor and the infiltrated dura were radically removed. The histopathology demonstrated an Anaplastic Meningioma. The patient also underwent radiation therapy.

Conclusion:  Treatment of recurrent meningioma with anaplastic histology remains challenging because recurrence rates remain high with a poor prognosis.


anaplastic meningioma, craniofacial approach


C. Wang. New development of diagnosis and treatment of malignant meningioma. Foreign Medicine-Neurology and Neurosurgery. 2003;30:159–62.

Iwami K, Momota H, Fujii M, et al. Anaplastic meningioma with rapid growth after omental flap transposition: a case report and experimental study. Brain Tumor Pathol. 2015;32:137-44.

Moradi A, Semnani V, Djam H, et al. Pathodiagnostic parameters for meningioma grading. J Clin Neurosci. 2008;15:1370-5.

Mahmood A, Caccamo DV, Tomecek FJ, Malik GM. Atypical and malignant meningiomas. Neurosurgery. 1993;33(6):955–63.

Dziuk TW, Woo S, Butler EB, et al. Malignant meningioma: an indication for initial aggressive surgery and adjuvant radiotherapy. J Neurooncol. 1998 Apr;37(2):177-88.

Modha A, Gutin PH. Diagnosis and treatment of atypical and anaplastic meningiomas: A Review. Neurosurgery. 2005;57(3):538–50.

Chamberlain MC. Intracerebral Meningiomas. Curr Treat Options Neurol. 2004 Jul;6(4):297-305.

Petridis AK, Doukas A, Mahvash M, et al. A case of rapid-growing anaplastic meningiomas. BMJ Case Rep. 2009;2009:bcr05.2009.1862.

Kim YJ, Ketter R, Henn W, et al. Histopathologic indicators of recurrence in meningiomas: correlation with clinical and genetic parameters. Virchows Arch. 2006 Nov;449(5):529-38.

Whittle IR, Smith C, Navoo P, Collie D. Meningiomas. Lancet. 2004;363:1535-43.

Durand A, Labrousse F, Jouvet A, et al. WHO grade II and III meningiomas: a study of prognostic factors. J Neurooncol. 2009 Dec;95(3):367-75.

Aras Y, Akcakaya MO, Aydoseli A, et al. Multiple atypical recurrent meningio¬mas 13 years after radiotherapy for unilateral retinoblastoma: case report and review of the literature. Neurol Neurochir Pol. 2013;47:80-5.

LeMay DR, Bucci MN, Farhat SM. Malignant transformation of recurrent meningioma with pulmonary metastases. Surg Neurol. 1989;31:365-8.

Thanc Foundation. Craniofacial Resection [Internet]. Canberra (AU): Thanc Guide; 2022 [cited 2022 Jan 27]. Available from:

Wilson CB. Meningiomas: genetics, malignancy, and the role of radiation in induction and treatment. J Neurosurg. 1994;81:666-75.

Liu Y, Liu M, Li F, et al. Malignant meningiomas: a retrospective study of 22 cases. Bull Cancer. 2007;94(10):27-31.

Li ZY, Cen Y, Gu M, Wei Y. Giant malignant meningioma invading the calvarial bone and scalp. J Craniofac Surg. 2012 Mar;23(2):599-602.

Kitamura Y, Akiyama T, Sasaki H, et al. Optic nerve seeding of atypical meningiomas presenting with subacute visual loss: 2 case reports with genetic characteriza-tion. J Neurosurg. 2013;119:494-8.

Tahir MZ, Shamim MS, Chishti KN. Recurrent atypical meningioma seeding to surgical scar. Neurology India. 2009;57(2):222.

Kruse F Jr. Meningeal tumors with extracranial metastasis. A clinicopathologic report of 2 cases. Neurology. 1960;10:197-201.

Buerki RA, Horbinski CM, Kruser T, et al. An overview of meningiomas. Future Oncol. 2018 Sep;14(21):2161-77.

Ermis I, Arinci A, Elmaci I, et al. The Treatment of Craniofacial Meningioma: A case report. The Journal of Psychiatry and Neurological Sciences. 1995;8(2):61-4.

Chohan MO, Ryan CT, Singh R, et al. Predictors of treatment response and survival outcomes in meningioma recurrence with atypical or anaplastic histology. Neurosurgery. 2017;82(6):824–32.

Full Text: PDF

DOI: 10.33371/ijoc.v16i4.910

Article Metrics

Abstract view : 90 times
PDF - 62 times


  • There are currently no refbacks.

Copyright (c) 2022 Indonesian Journal of Cancer