Involución espontánea de meningioma. Caso clínico y revisión de la literatura / Spontaneus involution of meningioma. Case report and literature review

Los meningiomas son tumores de las meninges cerebrales, de crecimiento lento y generalmente benignos, cuyo tratamiento es esencialmente quirúrgico. Presentan receptores de progesterona, y en menor medida de estrógeno, lo que les hace a veces tener crecimiento o disminución ligada a tratamiento hormonal. Es extremadamente raro que presenten involución espontánea. Presentamos el caso de un varón con un meningioma del planum esfenoidal. Como antecedentes tenía diabetes mellitus, miastenia gravis y un cáncer de próstata. Como tratamiento médico recibía, entre otros, análogos de la gonadotropina (leuprorelina), antiandrogénico (bicalutamida), agonistas β3 y bloqueantes α1. A los 15 meses del bloqueo hormonal se objetivó una reducción del tumor del 90% de su volumen. Los casos publicados previamente muestran que el tratamiento con análogos de la GnRH produce un crecimiento en algunos meningiomas. Existen otros casos publicados sobre reducción en pacientes diabéticos y en tratamiento con bloqueantes α1. Se revisa la literatura sobre meningiomas con involución espontánea (AU)

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), β3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed (AU)

Neurologically Asymptomatic Lumbar Traumatic Dislocation With Vascular Compression in a Patient With Ankylosing Spondylitis: Case Report.

BACKGROUND: Ankylosing spondylitis (AS) is associated with high rates of severe thoracolumbar fractures, in many cases with neurological deficits. It is currently a point of debate as to whether the optimal surgical treatment is posterior fixation and fusion or combined approaches. Vascular injuries in this kind of fracture are a challenging issue to solve in the management of these patients. METHODS: We are reporting the case of a 65-year-old man who presented an L4 traumatic fracture-dislocation. He had a long history of symptomatic AS. No neurological deficits were detected during the initial exploration. During the preoperative work-up, a lumbar spine computed tomography (CT) scan was taken with vascular reconstruction of the abdominal vessels. It confirmed the compression of the abdominal aorta, which had caused more than 90% stenosis. A posterior approach, an open reduction, and fixation with pedicle screws were performed, without hemodynamic or neurological changes. A postoperative angiography demonstrated a complete recovery of the vessel caliber, without contrast leaks. RESULTS: After a 2-year follow-up, the patient was pain free and the CT scan revealed bone fusion. CONCLUSIONS: The vascular structures involved in severe thoracolumbar fractures present a dangerous situation that should be considered in the choice of the surgical approach. The posterior approach alone may be a good option in the absence of vascular damage. However, due to risk of vessel rupture during the fracture reduction, vascular surgeons must take part in the surgery. LEVEL OF EVIDENCE: 5. CLINICAL RELEVANCE: The article provides help for surgeons who have to treat severe fractures in the context of ankylosing spondylitis.

Spontaneus involution of meningioma. Case report and literature review. / Involución espontánea de meningioma. Caso clínico y revisión de la literatura.

Meningiomas are tumors of the cerebral meninges, with slow growth and usually benign, whose treatment is essentially surgery. They have progesterone receptors, and to a lesser extent estrogen, which sometimes causes them to have growth or involution linked to hormonal treatment. Its spontaneous involution is extremely rare. We present the case of a male with a meningioma of the sphenoid planum. He had a history of diabetes mellitus, myasthenia gravis and prostate cancer. He was in treatment with analogs of GnRH (leuprorelin), antiandrogen (bicalutamide), ß3 agonists and α1 blockers. 15 months after the hormonal blockade, a reduction of the tumor of approximately 90% of its volume was detected. Previous reports show that treatment with gonadotropin analogues produces growth in some meningiomas. Other reports of spontaneous involution affect diabetic patients and patients in treatment with α1 blockers. Literature focus on meningiomas with spontaneous involution is reviewed.

Situación actual del uso de redes sociales en Neurocirugía en España / Current use of Social Media in Neurosurgery in Spain

Objetivo: Analizar la situación actual en España del uso de redes sociales en Neurocirugía. Materiales y métodos: Se realiza un estudio transversal y observacional entre febrero y marzo de 2017, mediante una búsqueda estructurada de las cuentas en Twitter, Facebook y YouTube de los servicios y unidades de Neurocirugía, sociedades científicas, publicaciones y asociaciones de pacientes relacionadas con la Neurocirugía. Se clasificaron según su popularidad. Resultados: Según nuestro estudio solo 5 servicios de Neurocirugía de la red pública tienen presencia en redes sociales, siendo inferior su popularidad a la de las unidades privadas. Las sociedades científicas y revistas neuroquirúrgicas tienen una presencia marginal, más aún en comparación con las de otras especialidades médicas. La popularidad de las asociaciones y grupos de apoyo es alta, sobre todo entre los pacientes, encontrándose mayor información sobre enfermedades que en las cuentas corporativas. Conclusiones: El uso en España de las redes sociales en Neurocirugía es bajo, en comparación con otras especialidades médicas. Existe un amplio campo de actuación para mejorar la popularidad de las cuentas, la difusión de la sociedad científica y la revista Neurocirugía y realizar funciones de promoción de la salud

Objective: To analyze the current situation in Spain of the use of Social Media in Neurosurgery. Materials and methods: We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. Results: According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. Conclusions: The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía

Current use of Social Media in Neurosurgery in Spain. / Situación actual del uso de redes sociales en Neurocirugía en España.

OBJECTIVE: To analyze the current situation in Spain of the use of Social Media in Neurosurgery. MATERIALS AND METHODS: We made an observational transversal study between February and March 2017, with a systematic search of the Facebook, Twitter and Youtube accounts from public and private neurosurgical units, scientific societies, peer-reviewed publications and patients groups in relation with Neurosurgical pathologies. We rank them according their popularity. RESULTS: According of our search only 5 public neurosurgical services have social media accounts, being their popularity inferior to the private units accounts. In relation with the scientific societies and neurosurgical publications their presence in social media is marginal, even more in comparison to the accounts of other medical specialities. The popularity of associations of patients and supporting groups is high, especially among patients, finding there more information about their disease. CONCLUSIONS: The use in Spain of Social Media about Neurosurgery is low in comparison to other medical specialities. There is a huge field to improve the popularity of the accounts, making in them promotion of health and extend the diffusion of the scientific society and the peer-reviewed publication Neurocirugía.

Anterior sacral meningocele presenting as intracystic bleeding.

PURPOSE: To report a case of anterior sacral meningocele with intralesional bleeding secondary to sacrococcygeal trauma. Likewise, there is a discussion about the physiopathology and the surgical approach to these types of lesions. METHODS: A 43-year-old man diagnosed with Marfan syndrome suffered sacrococcygeal trauma. He was admitted to the emergency room due to symptoms of headache, nausea, and lower limb subjective weakness. CT and MRI showed a large retroperitoneal mass with hemorrhagic content close to the sacrum. Likewise, the MRI showed an image compatible with subarachnoid hemorrhage in the thoracic spinal area, cerebral convexity, and the basal cisterns. The patient went into surgery for an anterior abdominal approach in the midline to reduce the content of the lesion, and subsequently, in the same act, a posterior approach was done with an S1-S2 laminectomy and obliteration of the pedicle. Postoperative MRI 5 months later showed resolution of the ASM. RESULTS: Anterior sacral meningocele is characterized by herniation of the dura mater and the arachnoid mater outside the spinal canal through a defect of the sacrum. We add the risk of bleeding after trauma-never seen in the literature-as one of the possible inherent complications of this lesion. CONCLUSIONS: This report highlights a complication never seen in the literature of a relatively rare condition. In our case, the combined approach was effective for both clinical control and lesion regression.

Neuralgia del trigémino secundaria a endostosis del hueso temporal / Trigeminal neuralgia secondary to petrous endostosis

La compresión neurovascular de origen arterial se postula como principal mecanismo de producción de la neuralgia primaria del trigémino. A pesar de ser la causa más frecuente, existen otras patologías, como los tumores localizados en el ángulo pontocerebeloso, capaces de producir dolor trigeminal. Presentamos el caso de una paciente de 44años con neuralgia del trigémino derecha sin respuesta al tratamiento médico. La RM cerebral previa no muestra signos de patología estructural. Durante la descompresión microvascular del nervio trigémino se encuentra endostosis de la cara interna del peñasco que provocaba compresión del V par. Tras el fresado completo y la descompresión microvascular desaparece de manera completa el dolor en el postoperatorio inmediato, manteniendo asintomática al año de la cirugía. La endostosis del hueso temporal es una causa muy infrecuente de neuralgia del trigémino. Una adecuada revisión de los estudios preoperatorios permitiría la optimización del manejo quirúrgico definitivo

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised

[Trigeminal neuralgia secondary to petrous endostosis]. / Neuralgia del trigémino secundaria a endostosis del hueso temporal.

Arterial neurovascular compression is hypothesised to be the main cause of primary trigeminal neuralgia. Although it is the most common cause, other pathologies, such as tumours in the cerebellopontine angle, can cause trigeminal pain. We report a case of a 44-year-old female patient with right trigeminal neuralgia without satisfactory response to medical treatment. Cerebral MRI showed no structural injuries. During microvascular decompression of the trigeminal nerve, endostosis of the internal aspect of the petrous bone was found to compress the trigeminal nerve. The pain disappeared completely in the early postsurgical period, after the complete drilling of the endostosis and microvascular decompression. The patient remains asymptomatic one year later. Endostosis of the petrous bone is a rare cause of trigeminal neuralgia. A proper review of preoperative studies would enable the definitive surgical approach to be optimised.

Hematoma subdural crónico / Chronic subdural hematoma

No disponible

Complicaciones de hardware en la estimulación cerebral profunda / Hardware complications of deep brain stimulation

No disponible

[Reversible porencephalic cyst related to shunt dysfunction]. / Cavidad porencefálica reversible secundaria a disfunción valvular.

INTRODUCTION: The surgical treatment of hydrocephalus is one of the most commonly procedures of modern pediatric neurosurgical practice, and cerebrospinal fluid shunts are the main means of treatment of hydrocephalus, being independent of site of obstruction and ventricular shunt complications are frequent, especially in children. The most common complications are shunt obstructions, mechanical disconnections, overdrainage and infection. CASE REPORT: A 7.5-year-old girl with ventriculoperitoneal shunt presented with intermittent headache. A head computed tomography scan revealed a cyst located in right temporal lobe. After ventriculoperitoneal shunt revision, a gradual resolution of the cyst was demonstrated on computed tomography. CONCLUSIONS: Cerebrospinal fluid porencephaly is a rare postoperative complication of a ventricular shunt that results from dysfunction of the distal catheter, especially in children with taut ventricles.

TITLE: Cavidad porencefalica reversible secundaria a disfuncion valvular.Introduccion. El tratamiento quirurgico de la hidrocefalia es uno de los procedimientos quirurgicos mas habituales en la neurocirugia pediatrica, y las derivaciones ventriculoperitoneales constituyen una herramienta fundamental en el tratamiento de la hidrocefalia tanto infantil como del adulto. Las complicaciones de las valvulas son relativamente frecuentes, sobre todo en la poblacion pediatrica, y, entre estas, las mas habituales incluyen: las obstrucciones, las desconexiones, el hiperdrenaje y las infecciones. Caso clinico. Niña de 7,5 años, portadora de una valvula ventriculoperitoneal, que presentaba cefalea intermitente. Un estudio con tomografia computarizada demostro una lesion quistica temporal derecha. Tras la revision valvular, la tomografia computarizada evidencio la reduccion del quiste. Conclusiones. La formacion de una cavidad porencefalica es una complicacion poco frecuente. Se relaciona con problemas en el cateter distal en pacientes con ventriculos dilatados y de las que existen escasas referencias en la bibliografia.

Cavidad porencefálica reversible secundaria a disfunción valvular / Reversible porencephalic cyst related to shunt dysfunction

Introducción. El tratamiento quirúrgico de la hidrocefalia es uno de los procedimientos quirúrgicos más habituales en la neurocirugía pediátrica, y las derivaciones ventriculoperitoneales constituyen una herramienta fundamental en el tratamiento de la hidrocefalia tanto infantil como del adulto. Las complicaciones de las válvulas son relativamente frecuentes, sobre todo en la población pediátrica, y, entre éstas, las más habituales incluyen: las obstrucciones, las desconexiones, el hiperdrenaje y las infecciones. Caso clínico. Niña de 7,5 años, portadora de una válvula ventriculoperitoneal, que presentaba cefalea intermitente. Un estudio con tomografía computarizada demostró una lesión quística temporal derecha. Tras la revisión valvular, la tomografía computarizada evidenció la reducción del quiste. Conclusiones. La formación de una cavidad porencefálica es una complicación poco frecuente. Se relaciona con problemas en el catéter distal en pacientes con ventrículos dilatados y de las que existen escasas ref rencias en la bibliografía (AU)

Introduction. The surgical treatment of hydrocephalus is one of the most commonly procedures of modern pediatric neurosurgical practice, and cerebrospinal fluid shunts are the main means of treatment of hydrocephalus, being independent of site of obstruction and ventricular shunt complications are frequent, especially in children. The most common complications are shunt obstructions, mechanical disconnections, overdrainage and infection. Case report. A 7.5-year-old girl with ventriculoperitoneal shunt presented with intermittent headache. A head computed tomography scan revealed a cyst located in right temporal lobe. After ventriculoperitoneal shunt revision, a gradual resolution of the cyst was demonstrated on computed tomography. Conclusions. Cerebrospinal fluid porencephaly is a rare postoperative complication of a ventricular shunt that results from dysfunction of the distal catheter, especially in children with taut ventricles (AU)

Quiste aracnoideo intraventricular / Intraventricular arachnoid cyst

Introducción. Los quistes aracnoideos intracraneales son lesiones congénitas de carácter benigno formadas por una membrana aracnoidea que contiene en su interior un líquido de características similares al líquido cefalorraquídeo. La prevalencia de estos quistes es alta en las primeras dos décadas de la vida, y es poco frecuente en ancianos; representan alrededor del 1% de todas las lesiones intracraneales ocupantes de espacio. Presentamos el caso de una paciente con un quiste aracnoideo intraventricular tratado endoscópicamente. Caso clínico. Mujer de 75 años que presenta una hemiparesia progresiva de dos años de evolución. La resonancia magnética craneal mostró una lesión quística intraventricular en la región parietooccipital derecha, con efecto masa local y moderada dilatación de los ventrículos laterales. A través de un agujero de trépano frontal derecho, se realizó una fenestración cistoventricular y apertura del septo pelúcido. No se presentaron complicaciones relacionadas con la cirugía y la paciente fue dada de alta asintomática. Conclusiones. La fenestración neuroendoscópica es un tratamiento efectivo para los quistes aracnoideos intraventriculares, con un escaso índice de complicaciones (AU)

Introduction. Intracranial arachnoids cysts are considered benign developmental anomalies that occur within the arachnoid membrane and generally contain clear and colourless fluid resembling cerebrospinal fluid. The prevalence of these cysts is higher in the first two decades of life, and the incidence is widely quoted as approximately 1% of all space-occupying intracranial lesions. Arachnoids cysts in the elderly person are a rare occurrence. We report the unusual presentation of a woman with an intraventricular arachnoid cyst treated with endoscopic technique. Case report. A 75-year-old woman presented with progressive hemiparesis of two years duration. Cranial MR imaging showed a right parieto-occipital intraventricular cyst with local mass effect and moderate dilatation of lateral ventricles. A right-sided burr hole was made and the arachnoids cyst was reached and cysto-ventricle shunting was realized. This was followed by a septum pellucidum fenestration. There were no complications during the surgery and the patient presented no symptoms at time of discharge. Conclusions. The neuroendoscopic approach to intraventricular arachnoid cysts was effective with few complications (AU)

[Intraventricular arachnoid cyst]. / Quiste aracnoideo intraventricular.

INTRODUCTION. Intracranial arachnoids cysts are considered benign developmental anomalies that occur within the arachnoid membrane and generally contain clear and colourless fluid resembling cerebrospinal fluid. The prevalence of these cysts is higher in the first two decades of life, and the incidence is widely quoted as approximately 1% of all space-occupying intracranial lesions. Arachnoids cysts in the elderly person are a rare occurrence. We report the unusual presentation of a woman with an intraventricular arachnoid cyst treated with endoscopic technique. CASE REPORT. A 75-year-old woman presented with progressive hemiparesis of two years duration. Cranial MR imaging showed a right parieto-occipital intraventricular cyst with local mass effect and moderate dilatation of lateral ventricles. A right-sided burr hole was made and the arachnoids cyst was reached and cysto-ventricle shunting was realized. This was followed by a septum pellucidum fenestration. There were no complications during the surgery and the patient presented no symptoms at time of discharge. CONCLUSIONS. The neuroendoscopic approach to intraventricular arachnoid cysts was effective with few complications.

TITLE: Quiste aracnoideo intraventricular.Introduccion. Los quistes aracnoideos intracraneales son lesiones congenitas de caracter benigno formadas por una membrana aracnoidea que contiene en su interior un liquido de caracteristicas similares al liquido cefalorraquideo. La prevalencia de estos quistes es alta en las primeras dos decadas de la vida, y es poco frecuente en ancianos; representan alrededor del 1% de todas las lesiones intracraneales ocupantes de espacio. Presentamos el caso de una paciente con un quiste aracnoideo intraventricular tratado endoscopicamente. Caso clinico. Mujer de 75 años que presenta una hemiparesia progresiva de dos años de evolucion. La resonancia magnetica craneal mostro una lesion quistica intraventricular en la region parietooccipital derecha, con efecto masa local y moderada dilatacion de los ventriculos laterales. A traves de un agujero de trepano frontal derecho, se realizo una fenestracion cistoventricular y apertura del septo pelucido. No se presentaron complicaciones relacionadas con la cirugia y la paciente fue dada de alta asintomatica. Conclusiones. La fenestracion neuroendoscopica es un tratamiento efectivo para los quistes aracnoideos intraventriculares, con un escaso indice de complicaciones.

Hematoma subdural crónico en pacientes jóvenes / Chronic subdural hematoma in young patients

Objetivos Analizar las características demográficas, clínicas, radiológicas y los resultados quirúrgicos de una serie de pacientes jóvenes con hematoma subdural crónico. Pacientes y métodos Estudio retrospectivo que incluye 42 pacientes con edad inferior a 40 años diagnosticados y tratados quirúrgicamente de un hematoma subdural crónico durante un período de 30 años (1982-2011).Resultados La serie consta de 32 varones y 10 mujeres con una edad media de 29,3±8,9 años (intervalo 4-39). El período transcurrido entre el traumatismo y el inicio de la sintomatología fue de 33,4±9,7 días (intervalo 19-95). Los principales síntomas de presentación fueron la cefalea (59,5%) y las crisis comiciales (21,4%), y los factores predisponentes más frecuentes fueron tener implantada una derivación ventrículo-peritoneal en 5 (11,9%) casos y los trastornos hematológicos en otros 5 (11,9%) pacientes. El hematoma fue derecho en 21 pacientes (50%), izquierdo en 19 (45,3%) y bilateral en los restantes 2 (4,7%). Se produjeron 2 complicaciones postoperatorias: un caso de recidiva y un hematoma subdural agudo sobre la cavidad del hematoma. No se produjeron muertes relacionadas con el tratamiento. Conclusiones El hematoma subdural crónico es una patología poco frecuente en las primeras décadas de la vida. Afecta con mayor frecuencia a los varones, y la forma de presentación más habitual es la cefalea. Los índices de recidiva y las complicaciones postoperatorias son significativamente inferiores que las presentes en otros rangos de mayor edad (AU)

Objective: The objective of this study was to analyse demographic, clinical and radiological findings and surgical results in a series of chronic subdural haematomas (CSDH) in young adult patients. Patients and methods: This retrospective study included 42 patients under 40 years of age who were diagnosed and surgically treated for a CSDH during a 30-year period (1982-2011).Results: Of the 42 cases analysed, 32 were males and 10 (..) (AU)

[Cervical lymphatic metastasis of an intracranial meningioma]. / Metastasis linfatica cervical de un meningioma intracraneal.

INTRODUCTION: Meningioma is the most common primary intracranial tumor, accounting for around a third of all primary brain tumor. In most cases, they are benign neoplasms that start in the cells of the arachnoid mater. Meningiomas are typically slow growing; however they can metastasize in 0.1% of all patients. CASE REPORT: A 45-years-old woman was admitted with a four weeks history of a painless enlarging mass in the right side of his neck and present in a MRI recurrence of the frontal meningioma surgically removed four times over the last 18 years. The patient underwent a complete removal of lesions and the microscopic observation showed an anaplastic meningioma in both (grade III of the World Health Organization). CONCLUSIONS: Metastatic meningioma is a rare cause of neck mass, but should be considered in any patient with a history of meningioma, especially if the tumor has histological features of malignant behavior. The present case demonstrates the aggressive biologic potential of an intracranial meningioma, with potential for distant spread and lymphatic invasion.

Metástasis linfática cervical de un meningioma intracraneal / Cervical lymphatic metastasis of an intracranial meningioma

Introducción. Los meningiomas constituyen el tumor intracraneal más frecuente y representan una tercera parte de todos los tumores cerebrales primarios. En la mayoría de las ocasiones se trata de una neoplasia histológicamente benigna derivada de células aracnoideas, y en menos del 0,1% de los casos pueden presentar metástasis a distancia. Caso clínico. Mujer de 45 años que mostraba desde hacía cuatro semanas una tumoración dolorosa en la cara lateral derecha del cuello. En una resonancia magnética se objetivaba recidiva de un meningioma intracraneal intervenido en cuatro ocasiones en los últimos 18 años. Se realizó la extirpación del tumor intracraneal y de la masa cervical y el diagnóstico histológico de ambas lesiones demostró un meningioma anaplásico de grado III según la clasificación de la Organización Mundial de la Salud. Conclusiones. Las metástasis de los meningiomas son una causa poco frecuente de tumoración cervical; sin embargo, deben tenerse en consideración en pacientes que han sido intervenidos previamente de un meningioma que evidenciaba datos histológicos de malignidad. Nuestro caso demuestra el potencial agresivo que pueden tener ciertos meningiomas intracraneales con capacidad para diseminarse a distancia e invadir los ganglios linfáticos (AU)

Introduction. Meningioma is the most common primary intracranial tumor, accounting for around a third of all primary brain tumor. In most cases, they are benign neoplasms that start in the cells of the arachnoid mater. Meningiomas are typically slow growing; however they can metastasize in 0.1% of all patients. Case report. A 45-years-old woman was admitted with a four weeks history of a painless enlarging mass in the right side of his neck and present in a MRI recurrence of the frontal meningioma surgically removed four times over the last 18 years. The patient underwent a complete removal of lesions and the microscopic observation showed an anaplastic meningioma in both (grade III of the World Health Organization). Conclusions. Metastatic meningioma is a rare cause of neck mass, but should be considered in any patient with a history of meningioma, especially if the tumor has histological features of malignant behavior. The present case demonstrates the aggressive biologic potential of an intracranial meningioma, with potential for distant spread and lymphatic invasion (AU)