Case Studies

Case 1 : Successful Surgical Management of WHO Grade II Atypical Meningioma with Mesh Cranioplasty

Introduction

Meningiomas are among the most common primary brain tumors. While many are benign, atypical (WHO Grade II) meningiomas carry a higher risk of recurrence and require timely surgical management and structured follow-up.

This case highlights the successful treatment of a symptomatic frontotemporal meningioma with gross total excision and immediate mesh cranioplasty, resulting in excellent neurological recovery and seizure control.

 

Patient Profile

  • Age/Gender: 45-year-old male

  • Presenting Complaints:

    • Progressive headache

    • Recurrent seizures

The patient presented with worsening headaches over several months along with new-onset seizure episodes. Given the neurological symptoms, urgent brain imaging was advised.

Diagnostic Evaluation

Magnetic Resonance Imaging (MRI) revealed:

  • Location: Right frontotemporal region

  • Lesion Type: Extra-axial mass

  • Radiological Impression: Suggestive of meningioma

  • Mass Effect: Significant compression of adjacent brain tissue

The imaging findings indicated a space-occupying lesion causing symptomatic mass effect, necessitating surgical intervention.

Surgical Procedure

The patient underwent a single-stage surgical procedure.

  • Approach: Right frontotemporal craniectomy

  • Tumor Resection: Gross total excision achieved

  • Intraoperative Findings:

    • Well-defined tumor margins

    • Moderately vascular lesion

  • Reconstruction: Immediate mesh plate cranioplasty performed in the same sitting

The tumor was completely removed without intraoperative complications, and cranial reconstruction was carried out using a mesh plate to restore skull integrity and contour.

Histopathological Diagnosis

Microscopic examination confirmed:

  • Diagnosis: Meningioma

  • WHO Grade: II (Atypical)

WHO Grade II meningiomas are associated with an increased risk of recurrence compared to Grade I tumors, making complete excision and regular follow-up essential.

Postoperative Outcome

  • Uneventful postoperative recovery

  • Significant improvement in headache

  • Effective seizure control

  • No new neurological deficits

  • Good functional recovery

The patient was discharged in stable condition and advised routine follow-up with serial imaging.

Conclusion

Timely surgical intervention with complete tumor excision remains the cornerstone of management for WHO Grade II atypical meningiomas. Combined with immediate mesh cranioplasty and structured postoperative follow-up, patients can achieve excellent functional outcomes and quality of life.

Regular clinical and radiological surveillance is essential to monitor for recurrence.