1. Different subtypes meningiomas arising in the same region M. Neroni, R. Gazzeri, G. Ricci e S. Esposito U.O.D. Neurosurgery, San Giovanni – Addolorata Hospital Rome M. Neroni, R. Gazzeri, G. Ricci e S. Esposito U.O.D. Neurosurgery, San Giovanni – Addolorata Hospital Rome

2. Introduction - Occurrence of multiple primary brain tumors is uncommon -Chordoid meningioma is a rare isthological entity - The association of two different subtypes meningiomas in the same region have not yet been reported Introduction - Occurrence of multiple primary brain tumors is uncommon -Chordoid meningioma is a rare isthological entity - The association of two different subtypes meningiomas in the same region have not yet been reported

3. Case Report - A 64 y.o. cauc. woman presenting with headaches since 5 months -Referred to our E.R. after acute onset of seizure - No neurological deficit were disclosed Case Report - A 64 y.o. cauc. woman presenting with headaches since 5 months -Referred to our E.R. after acute onset of seizure - No neurological deficit were disclosed

4. Case Report - Emergency CT showed a huge pterional hyperdense lesion - MR revealed two distinct lesions showing a different contrast enhancement Case Report - Emergency CT showed a huge pterional hyperdense lesion - MR revealed two distinct lesions showing a different contrast enhancement

5. Widened Pterional approach - Removing the anterior firm and larger tumor (intra-op histo exam revealed a chordoma) WHO II - Bone and muscle were infiltrated (Simpson I) - Cleavage between the lesions - Posterior mass was easily removed (intra-op histo exam revealed a transitional meningioma) WHO I Widened Pterional approach - Removing the anterior firm and larger tumor (intra-op histo exam revealed a chordoma) WHO II - Bone and muscle were infiltrated (Simpson I) - Cleavage between the lesions - Posterior mass was easily removed (intra-op histo exam revealed a transitional meningioma) WHO I

6. Histology - Anterior tumor: Chordoid Meningioma (Grade II WHO ) -Posterior mass: Transitional Meningioma (Grade I WHO ) Histology - Anterior tumor: Chordoid Meningioma (Grade II WHO ) -Posterior mass: Transitional Meningioma (Grade I WHO )

7. Conclusion - At nine months F.U. patient is still free disease - No radiotherapy was delivered -Control MR showed no recurrence Conclusion - At nine months F.U. patient is still free disease - No radiotherapy was delivered -Control MR showed no recurrence