Cystic meningioma originating from cavernous sinus: a case report

A 72-year-old man presented with gait disturbance and right homonymous hemianopsia. Magnetic resonance (MR) imaging showed a solid mass around the left cavernous sinus with rostral development of a multi-lobulated cystic component. The tumor was totally removed including the cystic wall via the left transsylvian approach with orbito-zygomatic craniotomy. Most of the tumor was attached to the lateral wall of the left cavernous sinus. Histological examination showed a meningioma WHO grade I with meningothelial meningioma formed lobules with intranuclear inclusions. His neurological symptoms disappeared immediately after the operation. Postoperative MR imaging revealed total removal of the tumor including the large cystic component.     

Huge falx meningioma resected en bloc following acute brain swelling: a case report

Surgery of a meningioma is composed of four essential consecutive steps; devascularization, detachment, debulking, and dissection. However, this is not the case with a huge meningioma in which circumferential devascularization and detachment may be difficult to complete before debulking is attempted. We report a case of a 37-year-old female presented headache, memory disturbance, and character change and sustaining a huge falx meningioma, with hypervascular appearance. Intraoperatively her blood pressure decreased to 45/30 mmHg due to profuse bleeding caused by "premature debulking" followed by significant brain swelling, which pushed out the tumor from the underlying brain after detachment of the tumor from the falx, and, consequently, yielded en bloc removal like a birth delivery. The histopathological diagnosis was angiomatous meningioma with prominent capillary proliferation without findings of celluar atypia. We thought that relative hyperemia in the brain surrounding the tumor, which was induced by the craniotomy, and acute brain ischemia caused by the intraoperative significant hypotension, might facilitate en bloc removal. We should be aware that huge meningiomas may cause intraoperative acute brain swelling as well as significant blood loss. Also we should carefully consider the indication and select proper candidates for presurgical cerebral angiography and tumor embolization because of the inherent risk that is apt to be underestimated.     

A case of intraosseous meningioma with extracranial progression having difficulty in making a preoperative diagnosis

Intraosseous meningioma is very rare and is often confused preoperatively with a primary bone tumor of the skull. We report a case of intraosseous meningioma with hyperostosis for which preoperative diagnosis was difficult. A 78-year-old female with a slowly growing hard mass in the left parietal bone was admitted. Neurological findings were normal. Plain skull radiograph showed a 6 x 6 cm hyperostotic lesion in the left parietal bone. Bone window CT scan showed thickening and hyperostosis in the same area. MRI using Gd-DTPA showed heterogeneous enhancement of the intraosseous mass, and homogenous enhancement of the dura matter. And angiogram showed a tumor stain fed by the bilateral superficial temporal artery and the It-occipital artery. The tumor and the underlying dura mater were totally removed. Preoperative diagnosis was an osteogenic tumor, but histological examination revealed a transitional meningioma. We discussed the development and the classification of an ectopic meningioma and the mechanism of hyperostosis. We should be aware of the existence of intraosseous menigiomas mimicking osteogenic tumors.     

Cystic meningioma: challenges in the diagnosis

A patient with an unusual cystic meningioma is described. The pathophysiology of cyst formation is discussed.     

Cavernous angioma of falx cerebri; case report]

A first case of cavernous angioma of falx cerebri is reported. A 62-year-old woman who had a history of intermittent headache and dizziness was admitted to our hospital. On admission she had no neurological deficit, but CT scan showed a slightly high density tumor located beneath the falx cerebri. This was markedly and homogeneously enhanced by contrast medium. MRI showed a tumor with low intensity in T1-weighted image and high intensity speckled with low intensity in T2-weighted image. Angiogram revealed a faint tumor-stain fed by the bilateral pericallosal arteries at middle arterial to late venous phases. With the tumor attached to the lower edge, the falx was totally removed through a left front-parietal craniotomy. Histologically the tumor was diagnosed as cavernous angioma and thought to have originated from the dura mater of the falx. A search in the literature revealed that only 7 cases of extracerebral cavernous angiomas excluding ones in the middle cranial fossa have been previously reported. Five of them were located at the tentorium cerebelli and two at the convexity. The MRI finding such as speckled mixed intensity may reflect the vascular lumens or their thromboses in the tumor. Angiographic finding such as faint tumor stain at middle arterial to late venous phases due to slow blood flow in the tumor are thought to be specific to intracranial cavernous angiomas. These findings are of particular importance in differentiating cavernous angiomas from meningiomas.     

Cystic meningioma associated with intratumor and subarachnoid hemorrhage during embolization--a case report

We present a case of a cystic meningioma accompanied with hemorrhage in a cyst and adjacent subarachnoid space that occurred while preoperative embolization in feeders for the tumor was being applied. A 73-year-old male patient was admitted for a complaint of convulsion. Under CT examination, a tumor was observed at the left frontal convexity and found to be fed by the middle cerebral artery shown in the left cerebral angiograms. The tumor was diagnosed meningioma. After removing the tumor, we conducted histological study. Gross findings of its cross section had an atypical bleeding pattern which was resulted from the ruptures of the criss-crossing internal and external carotid arteries in the tumor. The findings indicated that the tumor was an angiomatous meningioma and contained meningotheliomatous components. The hemorrhage was occurred in the portion of the angiomatous meningioma. The possible reason for the hemorrhage was thought that sudden dynamic changes in blood flow which were triggered by the embolization. The sudden changes could have caused multiple ruptures on pathologic small vessels. Therefore, we strongly recommend that preoperative embolization should be proceeded with caution for exercising a cyst meningioma, since it could increase the possibility of bleeding from pathologic weak vessels.     

Radiosensitive malignant meningioma presenting Garcin's syndrome: a case report]

A 58-year-old woman with Garcin's syndrome caused by malignant meningioma is reported. She first noticed left facial hypesthesia followed by left visual disturbance with exophthalmos. CT scan showed an enhanced mass extending from the left cavernous sinus to the left orbit. Cranial x-ray revealed bone deformity around the orbit. The tumor was subtotally resected and its histological type was shown to be anaplastic meningioma. After the initial surgery the patient was left with hyposmia, mild ptosis and incomplete 6th cranial nerve palsy on the left side. After one and half years, not only palsy of those cranial nerves but also that of other unilateral cranial nerves became progressively apparent due to tumor regrowth. In total, 11 nerves (2nd-12th) were affected by the tumor, without long tract signs or symptoms of increased intracranial pressure. Radiation therapy carried out after the 2nd surgery was extremely effective and resulted in the recovery of lower cranial nerve function. The tumor was founded to have disappeared completely on the 2-year follow-up CT.     

Intraparenchymal meningioma: an unusual radiologic and anatomic presentation of a meningioma. Case report

The authors describe a case of a completely intrinsic brain tumor which was resected totally and which proved to be a meningioma. In correlation with this anatomic diversity, the MRI findings also significantly differed from that of the known radiologic features of classical meningioma.     

Cystic meningioma: report of three patients.

Three patients with cystic meningioma are reported. The computed tomographic scans or magnetic resonance images of these tumors resembled those of a glial or metastatic tumor with cystic or necrotic changes. There is no definitive method for preoperatively differentiating cystic meningiomas from the more common malignant glioma. Angiographic evaluation and collaboration with a neuropathologist are important for the recognition of these potentially curable neoplasms.     

A meningioma associated with AVM: a case report

This paper reports a case of meningioma associated with AVM. A 67 years old lady showed transient rt. lower hemiparesis with severe headache, nausea and consciousness disorder. Bilateral carotid angiogram and CT scan revealed lt. convexity meningioma and AVM. Lt MCA and ACA entered into the AVM from which several draining vessels entered into the deep venous system. These two lesions were removed by one stage. It is quite rare that cerebral tumor associates with intracranial AVM. Only two cases of meningioma associated with AVM have been reported.     

Atypical neuroradiological features of microcystic meningioma: case report]

We report a rare case of microcystic meningioma presenting with atypical neuroradiological features. A 76-year-old woman was admitted to our hospital in October, 1996 because of head heaviness without obvious neurological deficits. Previous CT scan in 1989 revealed no abnormality, but a subsequent scan in 1992 showed a low-density area in the right frontal region. Since then the patient has been followed up as a case of cerebral infarction. At the time of the current admission, CT scan disclosed the low-density area as having grown to the size of 4 cm and heterogeneously enhanced after injection of contrast medium. On MRI the mass lesion was depicted as low-intensity on T1-weighted image and high-intensity on T2-weighted image. The mass was heterogeneously enhanced after administration of Gd-DTPA. Right internal and external carotid angiograms revealed neither tumor feeder nor tumor stain. Craniogram showed neither hyperostosis nor bone erosion, and yet bone scintigram demonstrated markedly increased uptake involving the right frontal bone near the tumor. At surgery the tumor was found to have originated from the dura in the right frontal convexity, which was well demarcated and separated from the surrounding brain tissue. Total removal designated as Simpson grade I procedure was accomplished. Light microscopy revealed abundant microcysts of varied size throughout the tumor tissue with the presence of whorl formation and psammoma body, but no malignancy was indicated. Electron microscopy further demonstrated interdigitation of the neighboring cell membranes, desmosomes, and intracytoplasmic filaments, which are pathognomonic findings of meningiomas. The microcysts were seen to reside in the extracellular spaces rather than in the cytoplasm. With these pathological findings, the tumor was finally diagnosed as microcystic meningioma.     

Metastasis of prostatic adenocarcinoma simulating a falx meningioma

A 56-year-old man, with known metastatic carcinoma of the prostate, presented with a single Jacksonian seizure. Examination revealed a tumor of the falx cerebri which demonstrated many characteristics of a meningioma. Although exceedingly rare, the tumor proved to be a meningeal metastasis of the prostatic adenocarcinoma. The relevant literature is reviewed.     

Scalp meningioma: case report

The authors report a case of scalp meningioma. The mass was removed totally, and all of the following neuroradiological studies proved the absence of an intracranial meningioma.     

Cystic peritoneal mesothelioma: report of a case

Benign multicystic peritoneal mesothelioma (BMPM) is a rare disease with good short-term prognosis and rare malignant transformation. However, its biological significance remains unexplained. A neoplastic origin is considered by many authors to require a surgical excision, based on the high recurrence and progressive growth rate of the tumors. However, alternative or integrative treatment options have also been proposed. A 45-year-old woman presented to our unit with a history of occasional discomfort and pain in the left hip. On physical examination, we noticed a tough-elastic, fixed mass located in the iliac fossa. Computed tomography scan detected a mass with multiseptated cystic-like areas. Due to the similarity of these findings to a primitive sarcomatous tumor of the retroperitoneum, an arteriographic study was also performed. The patient underwent en bloc resection of the mass, including a segment of the sigmoid colon. The final pathologic diagnosis was cystic mesothelioma. Further studies are needed to better understand the etiology and pathogenesis of this rare disease, and to define a more tailored treatment plan.     

Spinal-thoracic dumbbell meningioma: a case report.

STUDY DESIGN: Total excision of a large dumbbell cervicothoracic intra- and extraspinal meningioma that had grown into the posterior mediastinum is described. This excision involved a two-step neurosurgical-thoracosurgical procedure within a short interval. OBJECTIVES: To document that the described laminectomy and thoracotomy techniques are adequate, safe, and effective for the treatment of this intra- and extraspinal meningioma lesion. SUMMARY OF BACKGROUND DATA: The management of intra- and extraspinal dumbbell tumors is based on anecdotal reports of mostly neurinomas, and thus remains a controversial issue. Even large series of spinal meningiomas lack adequate information on how best to treat large cervicothoracic meningiomas. METHODS: The authors have modified standard techniques used for resection of spinal and mediastinal tumors, respectively, adapting them for a large, invasive dumbbell meningioma in a 72-year-old lady. The patient initially underwent laminectomy and microsurgical excision of the intraspinal tumor portions encasing vascular structures. A week thereafter, a thoracotomy was performed, and the mediastinal tumor portions were removed completely. RESULTS: Restitution was remarkably good. The patient, who had been unable to walk on her own, regained some mobility. At this writing, she was able to walk considerable distances without support. There was no evidence of tumor recurrence during a follow-up interval of 3 years. CONCLUSIONS: The authors recommend a two-staged procedure for complete excision of a large spinal-thoracic meningioma. Even in elderly patients with major neurologic deficits, an impressive recovery can be achieved with such lesions.     

Aneurysm occurring within a meningioma: case report

Aneurysms can be expected to be found in approximately 0.5% of patients with brain tumours; nevertheless, the real incidence is difficult to assess because angiography is now seldom performed for brain tumours. In the literature, 42 cases of meningioma associated with aneurysms are reported, but in none was the aneurysm intratumoural. We describe a case of intracranial meningioma with an intratumoural aneurysm in a 48-year-old woman.     

Werner's syndrome associated with meningioma: case report

We present two cases of Werner's syndrome associated with intracranial meningioma. Characteristic clinical features of Werner's syndrome include short stature with slender extremities, premature senility, juvenile cataract, skin changes, a tendency to diabetes mellitus and familial occurrence. A 44-year-old female, who had been treated for diabetes mellitus, was diagnosed as having Werner's syndrome because of various characteristic features. A falx meningioma was incidentally found on CT scan, and was surgically removed. Her diabetes mellitus improved. The second case was a 28-year-old male was diagnosed as having Werner's syndrome, diabetes mellitus, juvenile cataract, together with diabetes insipidus, and liver dysfunction. He developed severe headache, gait disturbance and then became unconscious with right hemiparesis. He was found to have a parasagittal meningioma by CT scan and angiography. After removal of the tumor, diabetes mellitus, diabetes insipidus and liver dysfunction improved. The reported incidence of neoplasms associated with Werner's syndrome is about 10%. The majority of associated tumors were mesenchymal in origin. Ten meningiomas, 1 neurinoma and 2 gliomas are reported as associated tumors in the central nervous system. Most of the associated meningiomas were asymptomatic and found incidentally at autopsies or CT scans. Diabetes mellitus associated with Werner's syndrome is generally mild with high immunoreactive insulin value and is controllable by diet therapy and oral antidiabetic drugs. Daily profile of blood sugar improved after the removal of tumor in our cases. In 50 gm glucose tolerance test, tendency of delayed appearance of peak value, which is common in Werner's syndrome, was not altered in our cases. Discussion is made as to the association of Werner's syndrome with meningioma and diabetes mellitus.