SURG-04. Intracranial Atypical Meningioma with Metastases to the Cervical Spine, Pleura and Lungs: A Case Report

Abstract INTRODUCTION Meningioma is one of the most common primary brain tumors, but extracranial metastasis is rare. We report a case of atypical meningioma with multiple extracranial metastases after multiple Gamma Knife radiosurgery (GKRS) treatments in our department. Case: A 46-year-old male patient with a left parietal parasagittal sinus tumor presenting with motor/sensory disfunction in the right lower limb had undergone two craniotomies at the referring hospital. The pathological diagnosis was an atypical meningioma, WHO grade 2. The patient was referred to our department for GKRS for local recurrence and underwent four rounds of GKRS and one tumor resection in our department. In addition, before the fourth GKRS procedure, a suspected metastatic lesion appeared in the cervical extradural space of the right eighth nerve root. This lesion was surgically removed in our department and the pathological diagnosis was metastatic atypical meningioma. The remaining tumor in the cervical spine was treated with intensity-modulated radiation therapy (IMRT, 50.4Gy/28Fr) at another hospital, and metastases were found almost simultaneously in the right pleura and lung. At the same hospital, the patient underwent resection, IMRT (60Gy/30Fr), and carboplatin/paclitaxel therapy for the residual tumor in the right pulmonary hilum. He visited the genomic diagnostics department of another hospital and underwent genetic testing, but the results were undruggable. Subsequently, two courses of nivolumab/ipilimumab therapy and 14 courses of docetaxel/ramucirumab therapy were administered. Additional nivolumab/ipilimumab therapy, hyperthermia, and three GKRS procedures were performed for pleural dissemination and local recurrence. However, tumor control was difficult and the patient died 103 months after the initial brain surgery. CONCLUSION Extracranial metastasis of high-grade meningiomas is rare and no standard treatment has been established. We report on this condition, focusing on surgery and GKRS, along with a literature review.