Intracranial meningioma and concomitant cavernous malformation: a series description and review of the literature

Objectives: Intracranial meningioma with concomitant cavernous malformation has been rarely described in theliterature. This study aimed to investigate the correct neurosurgical conduct.Patients and Methods: We retrieved clinical and radiological data for 39 outpatients or patients that underwentsurgery (mean age: 60 years; n = 25 females) for a single or multiple meningiomas and concomitant single ormultiple cavernous malformations. Cavernous malformations were classified according to Zabramski’s typescale. Our results were compared to results published in the literature.Results: All patients had at least one meningioma and at least one concomitant cavernous malformation. Mostmeningiomas and cavernous malformations were located in the supratentorial region. Nine patients (23 %) hadmultiple meningiomas and nine had concomitant multiple cavernous malformations. Cavernous malformationswere classified as type I (n = 0), type II (n = 9), type III (n = 11), or type IV (n = 19). The surgical priority wasmeningioma removal. A single patient underwent simultaneous removal of a meningioma and a contiguouscavernous malformation. In the postoperative period and long term follow-up, no complications occurred relatedto cavernous malformations, intra- or extra-lesional bleeding, or morphology/size changes. Years after surgicaltreatment, a new type IV cavernous malformation occurred in two patients.Conclusion: Our findings corroborate that meningioma removal should take priority in patients with intracranialmeningioma and concomitant cavernous malformation. Concomitant cavernous malformations showed nochange in morphology or size; therefore, they should merely be observed during follow-up. In patients thatharbor a single meningioma, a type IV cavernous malformation should preferably be considered a concomitantcerebral microbleed.