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Background <p>The association between chronic uncal herniation and meningioma is not well recognized. This rare presentation may represent a missed neurosurgical emergency. We report a case series of eight meningiomas with this unusual radiological finding, including patients’ clinical presentations, imaging characteristics, operative challenges, and surgical and neurological outcomes. Factors contributing to delays in seeking medical care, slow-track referrals, and their subsequent impact on management and outcome are examined.</p> Methods <p>Patients with histologically confirmed meningioma and radiologically reported uncal herniation between January 2017 and December 2021 were retrospectively reviewed.</p> Results <p>The study included 2 males and 6 females, with a mean age of 49.7 years. Four patients underwent surgery within 24&#xa0;h. All cases involved giant intracranial meningiomas, with the lateral sphenoid wing being the most common location. All patients had radiologically confirmed uncal herniation. Seven patients had WHO grade I tumors and underwent Simpson grade I resection, while one patient had a WHO grade III tumor and underwent Simpson grade III resection. Operative mortality was zero. Six patients were discharged with an mRS of 0–1, while two had mRS scores 3 and 4. The average duration of delayed management was 4 months. Preoperative GCS ≥ 13 and absence of neurological deficits were associated with better outcomes. Delayed surgical intervention correlated with worse outcomes.</p> Conclusion <p>The association between chronic uncal herniation and meningioma is not well recognized, yet it should alert healthcare providers to the urgency of intervention. Delays in referral and surgical treatment may result in sudden deterioration and even death. Establishing efficient referral pathways and ensuring timely surgical management are essential to prevent avoidable morbidity and mortality.</p>

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Meningioma with chronic uncal herniation: a missed neurosurgical emergency

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月10日

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  • Mohammad Ghazi Abdoh,
  • Balgees Ajlan,
  • Hussein Kheshaifati,
  • Yoseri Alhamss,
  • Abdelmoneim Kamar,
  • Zaina Siraj Brinji,
  • Alaa Alkhotani,
  • Ahmed Adel Farag

摘要

Background

The association between chronic uncal herniation and meningioma is not well recognized. This rare presentation may represent a missed neurosurgical emergency. We report a case series of eight meningiomas with this unusual radiological finding, including patients’ clinical presentations, imaging characteristics, operative challenges, and surgical and neurological outcomes. Factors contributing to delays in seeking medical care, slow-track referrals, and their subsequent impact on management and outcome are examined.

Methods

Patients with histologically confirmed meningioma and radiologically reported uncal herniation between January 2017 and December 2021 were retrospectively reviewed.

Results

The study included 2 males and 6 females, with a mean age of 49.7 years. Four patients underwent surgery within 24 h. All cases involved giant intracranial meningiomas, with the lateral sphenoid wing being the most common location. All patients had radiologically confirmed uncal herniation. Seven patients had WHO grade I tumors and underwent Simpson grade I resection, while one patient had a WHO grade III tumor and underwent Simpson grade III resection. Operative mortality was zero. Six patients were discharged with an mRS of 0–1, while two had mRS scores 3 and 4. The average duration of delayed management was 4 months. Preoperative GCS ≥ 13 and absence of neurological deficits were associated with better outcomes. Delayed surgical intervention correlated with worse outcomes.

Conclusion

The association between chronic uncal herniation and meningioma is not well recognized, yet it should alert healthcare providers to the urgency of intervention. Delays in referral and surgical treatment may result in sudden deterioration and even death. Establishing efficient referral pathways and ensuring timely surgical management are essential to prevent avoidable morbidity and mortality.