2025 Poster Presentations
P142: THE MULTIPLE FACES OF MENINGIOMAS: DEMONSTRATING ATYPICAL APPEARANCES OF MENINGIOMAS
Florian Stumpf, MD; Daniel Wang, MD; Ann K Jay, MD; Rashmi S Thakkar, MBBS; MedStar Georgetown University Hospital
Meningiomas are the most common primary central nervous system neoplasm, making up more than a third of central nervous system tumors. While the majority of meningiomas exhibit the classic imaging characteristics of a homogeneous, avidly enhancing, well-defined extra-axial mass, often with a dural tail and/or CSF cleft in characteristic locations along the calvarium and skull base, they can occasionally present with atypical features that may cause diagnostic dilemmas. Atypical meningiomas may demonstrate invasion into skull base foramina, resulting in cranial neuropathies, and dural venous sinuses, both of which can complicate surgical resection and alter prognosis. In some cases, meningiomas may arise in unexpected locations, such as the ventricles or intraosseous, or may demonstrate aggressive features, including heterogeneity, rim enhancement, low ADC values, and significant surrounding vasogenic edema, which may simulate malignant brain tumors. It is also important to be aware of the varied appearances of atypical (WHO grade II) and anaplastic (WHO grade III) meningiomas, which while generally expected to demonstrate lower ADC values, have to date not expressed definite differential criteria from typical (WHO grade I) meningiomas. Because of the importance of accurate diagnosis for prognosis and treatment, awareness and recognition of some of the atypical presentations of meningiomas is vital.