Meningiomas Associated with Subdural Hematomas: A Systematic Review of Clinical Features and Outcomes

BACKGROUND: Meningiomas associated with subdural hematomas (SDHs) are exceedingly rare. As such, the clinical features, optimal medical and surgical management, and outcomes of treatment for these lesions remain unknown. METHODS: We performed a systematic review of the PubMed and Scopus databases for case reports and case series of patients with presumptive clinical or definitive diagnoses of meningiomas presenting with SDH on computed tomography scan or magnetic resonance imaging. Data on demographics, clinical manifestations, surgical management, adjuvant treatment, and outcome on last follow-up were collected. RESULTS: Inclusion criteria were met by 59 cases, including a case described in the current study. Mean age of patients was 62 years (range: 5-85 years), with a slight female predilection (1.3:1). The most common clinical symptom and sign were headache and focal weakness, respectively. All except 2 patients underwent surgery, either a single or staged procedure, for evacuation of hematoma and/or excision of tumor. Treatment for meningioma in patients who presented with SDH was associated with a mortality rate of 12% (6/51) at a median follow-up of 3 months. Complete neurologic recovery was reported in 71% of patients. CONCLUSIONS: SDHs are rare manifestations of intracranial meningiomas. Current management is largely surgical for immediate relief of mass effect and oncologic control. Most reported patients survived with complete neurologic recovery.