title: Scalp Metastases of Recurrent Meningiomas: Aggressive Behavior or Surgical Seeding?
abstract: OBJECTIVE
  Scalp metastases of meningiomas seldom have been reported. Here, we report a series of 4 cases of this rare event and discuss the relevant potential risk factors.
  
  
  METHODS
  We performed a retrospective review of patients treated for scalp metastases of meningiomas at our institution. A literature review was performed for the terms "scalp meningioma," "cutaneous meningioma," "skin meningioma," "extracranial meningioma," and "subcutaneous meningioma."
  
  
  RESULTS
  Four patients showed scalp metastases of recurrent meningiomas with the following associated clinical features: multiple reoperations (n = 4), immunosuppression (n = 2), radiation therapy (n = 3), surgical wound complications with cerebrospinal fluid fistula (n = 2), and histologic grade progression (n = 2). The timescale for development of scalp metastasis was between 5 months and 13 years after intracranial meningioma surgery. In all cases, the metastases were located close to the surgical scalp incision for the craniotomy. Previously, 11 cases of meningioma with scalp metastasis, with similar features to those described here, were reported in the literature.
  
  
  CONCLUSIONS
  Spreading of meningioma cells during surgery is a possible mechanism for scalp metastases of recurrent meningiomas. Factors associated with scalp metastases include reoperations, immunosuppression, radiation therapy, torpid course of the surgical wound with cerebrospinal fluid fistula, and histologic progression. Awareness of these features is advisable for neurosurgeons involved in the care of patients with similar profiles.
authors.affiliation: Department of Neurosurgery, Hospital Clínico San Carlos, Madrid, Spain; Department of Neuropathology, Hospital Clínico San Carlos Madrid, Madrid, Spain. Electronic address: josue.avecillas@salud.madrid.org.
authors.forename: Josue M
authors.initials: JM
authors.lastname: Avecillas-Chasin
authors.affiliation: Department of Neurosurgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Saceda-Gutierrez
authors.affiliation: Department of Neurosurgery, Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Alonso-Lera
authors.affiliation: Department of Plastic Surgery, Hospital Clínico San Carlos Madrid, Madrid, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Garcia-Pumarino
authors.affiliation: Department of Neuropathology, Hospital Clínico San Carlos Madrid, Madrid, Spain.
authors.forename: Subhi
authors.initials: S
authors.lastname: Issa
authors.affiliation: Department of Radiation Oncology, ONCOSUR, Granada, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain.
authors.forename: Escarlata
authors.initials: E
authors.lastname: López
authors.affiliation: Department of Neurosurgery, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, Spain; Department of Surgery, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Barcia
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001921:Brain / Q000473:pathology*; D002555:Cerebrospinal Fluid; D003399:Craniotomy; D018450:Disease Progression; D005402:Fistula / Q000209:etiology; D006801:Humans; D007150:Immunohistochemistry; D007165:Immunosuppression Therapy; D019394:Ki-67 Antigen / Q000032:analysis; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000150:complications / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D008579:Meningioma / Q000150:complications / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D009366:Neoplasm Seeding; D016634:Radiosurgery; D018714:Radiotherapy, Adjuvant; D012086:Reoperation; D012189:Retrospective Studies; D012535:Scalp / Q000473:pathology*; D012878:Skin Neoplasms / Q000556:secondary*; D013530:Surgical Wound Infection / Q000209:etiology; D014786:Vision Disorders / Q000209:etiology
chemical_list: D014408:Biomarkers, Tumor; D019394:Ki-67 Antigen
keywords: Cutaneous meningioma; Meningioma; Scalp meningioma; Skin meningioma; Subcutaneous meningioma