Deciphering extracranial metastasis in high-grade meningiomas: insights from a case study and literature review.

Abstract

Introduction and importance: These high-grade meningiomas have higher recurrence rates and poorer survival outcomes compared to benign variants. This study presents a case of metastasis in a high-grade meningioma and a comprehensive analysis of the literature published between 2000 and 2023, including only original studies focused on extracranial metastasis.

Case presentation: We report the case of a 45-year-old female who presented with progressive left-sided weakness and partial seizures. Imaging revealed a large, lobulated extra-axial mass in the right parietal parasagittal region, which was surgically resected and diagnosed as an anaplastic meningioma (WHO grade III). Despite an initial recovery, the patient experienced tumor recurrence with local invasion, multiple metastases to the contralateral brain, liver, lung, spine, and long bone. Various treatments, including radiotherapy, chemotherapy, and surgery, were employed, but the disease progressed, leaving the patient bed-bound at 8 years follow up.

Clinical discussion: In our literature review, encompassing 247 patients with extracranial metastasis of meningiomas from seven studies, the lungs and bones were the most common metastatic sites. Patients with grade III meningiomas had poorer survival outcomes than those with grade II. Gross total resection (GTR) was associated with improved progression-free survival, while recurrence markedly reduced overall survival, underscoring the aggressive nature of metastatic meningiomas and the importance of early, comprehensive treatment strategies.

Conclusion: Extracranial metastasis in high-grade meningiomas poses significant diagnostic and therapeutic challenges. Our analysis underscores the complexity of managing these cases and highlights the critical need for early identification of high-risk patients and tailored treatment protocols to improve long-term outcomes.