(Kiosk 1) Surveillance, Surgery, & Rehabilitation in Multiple Meningiomatosis: A Case Report

Case Diagnosis: Cauda Equina Syndrome secondary to meningioma

Case Description or Program Description: 72-year-old female with history of multiple meningiomatosis of brain and spine (T2-T3, T6-T7, T10-T11) with recent T10-T11 laminectomy and tumor resection (atypical meningioma WHO Grade II) presented with lower back pain, worsening numbness of abdomen and legs and gait instability. Imaging showed large meningioma at T2-T3 with severe cord compression and severe canal stenosis at L4-L5 from degenerative changes. Two months later, she presented with acutely worsening symptoms and new-onset fecal and urinary incontinence, consistent with Cauda Equina Syndrome.

Setting: Inpatient rehabilitation facility

Assessment/Results: Neurosurgery performed thoracic laminectomy at T2-T4, tumor resection, and L4 laminectomy. Patient’s incontinence resolved but weakness persisted. She was admitted for inpatient rehabilitation due to functional decline. Physical examination on admission was 4/5 upper extremity strength throughout and 3/5 lower extremity strength throughout. Patient progressed well in therapy, and by discharge she was modified independent with activities of daily living and ambulating 300 feet with rollator.

Discussion (relevance): Meningiomas are common brain tumors, accounting for approximately a third of all primary brain tumors in adults. Multiple meningiomas are defined as the presence of two or more spatially-separated lesions and occur in up to 10% of meningiomas. They are commonly associated with neurofibromatosis type 2 and familial meningiomatosis. Multiple meningiomatosis poses a special management challenge because there are no definitive guidelines due to the rarity of this illness; in fact, most published research is on case reports. The multidisciplinary oncology team must decide whether the patient is symptomatic enough, which lesion is responsible, if intervention is required, and when to initiate treatment.

Conclusions: Multiple meningiomatosis is a rare disease entity, and often patients are asymptomatic, due to small and slow-growing lesions. This case demonstrates the importance of symptom surveillance by physiatry, surgery, and radiation oncology.