Two supratentorial meningiomas: are they different?

DESCRIPTION A 65-year-old woman comes for headache management. Few years ago, she was diagnosed with a ‘single benign tumour of the anterior part of the brain’. A new contrast CT brain scan was done (figures 1 and 2); as she was claustrophobic, brain MRI was not ordered. The mass they have referred to was most likely a falcine meningioma. In addition, there is an oval hyperdense mass at the right temporal area, which is diffusely and homogenously calcified and seems to sit on the pertrous temporal bone, a finding that may well refer to another meningioma. Multiple meningioma refers to the simultaneous (or sequential) appearance of two or more independently located meningiomas, not necessarily of the same pathological subtype and without signs of neurofibromatosis type II. Their incidence ranges from 1% to 10% of all meningiomas. They are more commonly found in the supratentorial compartment. The patient harbours a frontal falcine meningioma with a surrounding vasogenic oedema of the white matter. The right temporal meningioma’s peritumoural area demonstrates no oedema. Counting on this oedema, one may presume that the former is a secretory, atypical or even malignant meningioma while the latter is a classical or typical meningioma. Souto et al found that two-thirds of their patients with intracranial meningioma demonstrated peritumoural oedema and that the site and size of the tumour were probably related to the development of this oedema. The patient’s long history can exclude atypical/ malignant pathology. She has a classical temporal and a classical (or secretory) frontal meningiomas.