Ricerc@Sapienza

Objectives: Intracranial meningioma with concomitant cavernous malformation has been rarely described in the
literature. This study aimed to investigate the correct neurosurgical conduct.
Patients and Methods: We retrieved clinical and radiological data for 39 outpatients or patients that underwent
surgery (mean age: 60 years; n = 25 females) for a single or multiple meningiomas and concomitant single or
multiple cavernous malformations. Cavernous malformations were classified according to Zabramski’s type
scale. 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. Most
meningiomas and cavernous malformations were located in the supratentorial region. Nine patients (23 %) had
multiple meningiomas and nine had concomitant multiple cavernous malformations. Cavernous malformations
were classified as type I (n = 0), type II (n = 9), type III (n = 11), or type IV (n = 19). The surgical priority was
meningioma removal. A single patient underwent simultaneous removal of a meningioma and a contiguous
cavernous malformation. In the postoperative period and long term follow-up, no complications occurred related
to cavernous malformations, intra- or extra-lesional bleeding, or morphology/size changes. Years after surgical
treatment, a new type IV cavernous malformation occurred in two patients.
Conclusion: Our findings corroborate that meningioma removal should take priority in patients with intracranial
meningioma and concomitant cavernous malformation. Concomitant cavernous malformations showed no
change in morphology or size; therefore, they should merely be observed during follow-up. In patients that
harbor a single meningioma, a type IV cavernous malformation should preferably be considered a concomitant
cerebral microbleed.