- Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Andhra Pradesh, India
DOI:10.4103/2152-7806.107907Copyright: © 2013 Bramhaprasad V This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Bramhaprasad V, Rajesh A, Kumar A. Mysterious meningioma: Surviving the odds. Surg Neurol Int 27-Feb-2013;4:29
How to cite this URL: Bramhaprasad V, Rajesh A, Kumar A. Mysterious meningioma: Surviving the odds. Surg Neurol Int 27-Feb-2013;4:29. Available from: http://sni.wpengine.com/surgicalint_articles/mysterious-meningioma-surviving-the-odds/
Clinical and imaging markers are a part and parcel of decision-making in neurosurgery, often prompting the surgeon to intervene before doom strikes. But, nature and its mechanisms, best not understood, do play a vital role. We herein present a case, which survived the odds, including the odds by neurosurgeon to teach us a lesson on the mystery of nature.
A 62-year-old female presented with history of seizures of 8 years duration and was worked up as a case of left temporo-parietal meningioma 7 years back and was kept on phenytoin. She also had a history of left hemicranial headache, which was partially relievable with medications. She presented to our outpatient department with history of increased seizure frequency and severity of headache with associated occasional vomitings. There was no other significant history. On examination, the patient was remarkably preserved with no focal sensory or motor deficits.
She presented with previous imaging done 7 years ago, which to our astonishment was showing a well-defined 4 × 5 × 5 cm extra-axial lesion in the left temporo-parietal region with squashing of ipsilateral ventricle and significant mass effect and midline shift to the opposite side and considerable peri-lesional edema [
The presented case assumes significance in many contexts. First, with the first scan done 7 years ago, none could have contemplated a conservative approach, and an emergency surgical excision of the lesion would have been the top priority on any attending surgeon's mind. Second, despite any surgical intervention for such a long duration of 7 years, the patient remained well-preserved with no focal deficits or any deterioration, except for a recent increase in seizure frequency. Third, this underscores the paramount role of neuronal plasticity of the brain and other accommodative mechanisms responsible for the preserved neurological status over such a long duration. One also needs to take into account that since it being a meningioma imageologically, the expected rate of growth is around 1-2 mm per year. But, since a significant peri-lesional edema was already present in the very first image, the possibility of a malignant meningioma could not be ruled out.
A review of literature was done in this context, and it was observed in a study on outcomes of untreated meningiomas by Rubin, et al. that[
This case epitomizes the role of plasticity of the human brain and unquestionably redefines the role of emergent surgical intervention in cases with large malignant meningiomas with significant mass effect and midline shifts.
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