Multiple Meningiomas in a 32-Year Old Male with 20 Intracranial Masses: Case Report and Literature Review

Introduction: Multiple meningiomas are not unknown but are generally rare. It is a condition where more than one meningioma is located in several intracranial sites in the same individual and without signs of neurofibromatosis. Objectives: To present a case report of multiple meningiomas in a 32-year old male with up to 20 meningiomas at different sites in the brain. Materials and Methods: We present a 32-year-old male who presented to our outpatient department with history of recurrent seizures of 10 months duration, with associated recurrent headaches and progressive loss of sensorimotor function in the lower limbs about 1 year prior to presentation for which he was diagnosed of a spine tumour and had a spine surgery about 9 months prior to presentation. Results: Neurological examination revealed a conscious young man on a wheel chair, with paraparesis of the lower limbs. Magnetic resonance imaging of the brain revealed multiple homogeneous contrast enhancing intracranial masses of varying sizes and location in the supratentorial and infratentorial compartment, which on careful assessment were up to 20 separate masses. Management decision was quite challenging. After detailed counseling, a right convexity frontal mass was excised for histological diagnosis which revealed a chordoid meningioma, WHO grade II. He was further counseled and referred to the Oncologist. He has had radiotherapy and has remained in stable condition since discharge. Conclusion: This single and first experience of multiple meningiomas in our environment with tumour located mostly in the cranial convexity may corroborate a subarachnoid tumor–seeding hypothesis to account for the origin of these tumors. Treatment should be individualized based on the presenting symptoms, number of tumours, tumour location and histological subtype.