multiple meningiomas
Introduction
Introduction to multiple meningioma More than two meningiomas that are not connected to each other in the brain are called multiple meningiomas, and about 400 cases have been reported in the literature. In 1822, Wishart first reported a case of a 21-year-old man with multiple meningioma, which had both skull thickening and bilateral neuroma. According to modern wisdom, about half of the patients reported to be in the literature of type II neurofibromatosis (Recklinghausen's disease) were diagnosed with multiple meningiomas for the first time, and about half of the patients were diagnosed for the first time. One or more meningiomas were found in other areas during the time. Multiple meningiomas are more common in the convex surface of the brain, scattered around a meningioma, or in the base of the skull. Sometimes, multiple meningiomas appear in the ventricles and outside the brain, or both on the screen and under the curtain. In addition, intracranial meningioma and acoustic neuroma or intraspinal meningioma are common in clinical practice. Any type of meningioma can be found in multiple meningiomas. basic knowledge The proportion of sickness: 0.01% Susceptible people: no specific people Mode of infection: non-infectious Complications: cerebral edema
Cause
Cause of multiple meningioma
(1) Causes of the disease
In addition to the combination of neurofibromatosis is considered to be related to cytogenetics, the etiology of multiple meningioma is still unclear. Multiple meningioma recurring after meningiomas can be explained by the dissemination of tumor cells with cerebrospinal fluid, but it cannot be explained. In the primary multiple meningiomas, Borovich et al observed 14 cases of meningeal meningioma, and found that there are scattered lesions on the dura mater around the tumor. These lesions are clustered in the dural layer, and any pathological type can be used. In multiple meningioma, meningioma of different pathological types can occur in the same patient.
(two) pathogenesis
There are two kinds of lesion theory and single lesion theory. The multi-lesion theory believes that the patient's environment is the same, so the tumor may occur in multiple arachnoid cells at the same time; the single lesion theory is considered to be the shedding tumor cells. New tumors produced by cerebrospinal fluid circulation or blood circulation dissemination. Histologically, multiple meningioma can be of the same pathological type or different pathological types.
Prevention
Multiple meningioma prevention
Prevention: Pay attention to food hygiene and avoid carcinogens such as benzopyrene and nitrosamines from entering the body. Pay attention to personal hygiene, exercise, enhance resistance and prevent viral infection.
Complication
Multiple meningioma complications Complications brain edema
Depending on the location of the tumor, complications may occur after surgery. For surgical treatment, the following complications may occur:
1. Intracranial hemorrhage or hematoma is not related to intraoperative hemostasis. With the improvement of surgical techniques, this complication has been less frequent. The wound is carefully hemostasis and repeated flushing before closing the skull can reduce or avoid postoperative intracranial hemorrhage.
2. Cerebral edema and postoperative high intracranial pressure can reduce intracranial pressure with dehydrating drugs, and glucocorticoids can alleviate brain edema.
3. The loss of nerve function is related to the important functional area and important structure of intraoperative injury. The injury should be avoided as much as possible during the operation.
Symptom
Multiple meningioma symptoms Common symptoms Deep headache Lower extremity swelling and fatigue nausea and vomiting Visual impairment Increased intracranial pressure
The location of multiple meningiomas is variable, so the clinical manifestations are also diversified. The localized symptoms or signs of multiple tumor sites can occur at the same time, but the symptoms of the larger tumors are often obvious, such as bilateral tumors often One side of the symptoms is predominant, and there are few bilateral symptoms at the same time. After the tumor is removed, the symptoms of the other side of the tumor are more obvious. Compared with single meningioma, multiple meningioma intracranial pressure The symptoms of augmentation are more prominent because the total volume of multiple tumors grows faster than a single tumor. The most common clinical symptoms are headache, nausea, vomiting, limb weakness, visual impairment, etc., and the incidence of epilepsy is lower than single incidence. Meningioma, patients with acoustic neuroma or intraspinal meningioma have corresponding symptoms or signs.
Examine
Examination of multiple meningioma
CT or MRI, CT scan can easily find those larger meningioma that occur in the convex surface of the brain, the parasagittal sinus, the ventricle and the posterior fossa, but the smaller tumors that occur at the base of the skull. It is difficult to find, so it is necessary to strengthen CT scan, especially when the clinical symptoms of patients are complicated. In the case of inconsistent clinical and imaging, the performance of multiple meningioma in CT or MRI is the same as that of single meningioma. CT can The calcification of meningioma is clearly found, especially in mixed or fibrous meningioma. CT can also show cystic changes of the tumor and its surrounding cerebral edema, which often occurs in vascular-rich meningioma.
On the T1 image of MRI, almost 30% of meningiomas are low-signal, 60% are equal signals, T2 is like the signal of meningioma, 50% is equal signal, 40% is high signal, contrast agent is injected It is helpful to improve the resolution of the image.
Diagnosis
Diagnosis and diagnosis of multiple meningioma
It is difficult to diagnose multiple meningioma by traditional cephalogram, cerebral angiography and ventriculography. Today, CT and MRI can easily diagnose multiple intracranial meningioma.
Note that unlike the single meningioma, the application of MRI can help the differential diagnosis of multiple meningioma, especially its sagittal and coronal enhanced scan, which can clearly show the meningioma at the base of the skull, and can clearly Displaying the tumor base helps to distinguish multiple tumors that are adjacent to the basal tumor.
