Meningioma

Epidemiology

Intracranial meningiomas are the most common nonglial tumor. Extracranial meningiomas are uncommon and may be found in relation to the optic nerve. Rarely, meningiomas originating in the posterior cranial fossa may extend into the jugular foramen and beyond into the neck along the carotid sheath. These tumors are most commonly seen in middle age and show a predilection for females. Meningiomas may be multiple in 1 to 8% of patients and are associated with neurofibromatosis (NF-2).

Clinical Findings

Small meningiomas involving the jugular foramen may be asymptomatic. Larger legions typically present with multiple lower cranial nerve palsies. The most common complaint is hoarseness of voice and signs of vocal cord palsy. In addition, lesions that track down the carotid sheath may be sufficiently low to become palpable.

Pathology

The histologic patterns of meningiomas are variable and can be divided into three classic types: meningotheliomatous, fibroblastic, or transitional. The majority of reported jugular foramen meningiomas are classified as meningotheliomatous. Meningiomas may also be classified into four grades: benign, atypical, anaplastic, and sarcomatous. Six percent of jugular foramen lesions are meningosarcomas. In addition, meningiomas are classified according to morphological appearances: globular (most common), en plaque, and multicentric (least common).