Primary intraorbital ectopic meningioma

We report a case of intraorbital meningioma. Operative findings and histopathological examination revealed the tumoc to be meningothelial meningloma and to be located entirely outside the optic dura. This case demonstrates the occurrence of primary intraorbital ectopic meningioma, and the tumor was removed through a modified Dolenc approach. The primary intraorbital ectopic meningioma is discussed and the surgical approach to the orbital apex region is reviewed.     

Primary ectopic frontotemporal craniopharyngioma

IntroductionPrimary ectopic craniopharyngiomas have only rarely been reported. Craniopharyngiomas involve usually the sellar and suprasellar region, but can be originated from cell remnants of the obliterated craniopharyngeal duct or metaplastic change of andenohypophyseal cells. We present the first case of a primary ectopic frontotemporal craniopharyngioma.Presentation of caseA 35-year old woman presented with a one-year history of headache and diplopia. MRI showed a large frontotemporal cystic lesion. Tumor resection was performed with a keyhole endoscopic frontal lateral approach. The pathological features showed an adamantinomatous craniopharyngioma with a cholesterol granuloma reaction.DiscussionThere have been reported different localizations for primary ectopic craniopharyngioma. Our case presented a lobulated frontotemporal cystic mass formed by a dense eosinophilic proteinaceous material dystrophic calcifications and cholesterol crystals, with epithelial remnants. No tumor regrowth was observed in the magnetic resonance image 27 months postoperatively.ConclusionPrimary ectopic craniopharyngioma is a rare entity with a pathogenesis that remains uncertain. This is an unusual anatomic location associated with unique clinical findings.     

原发性颅骨囊实性脑膜瘤1例

正患者女,25岁,因"左额肿物进行性增大1年"入院。体格检查:左侧额部一直径约3cm肿物,质硬,无压痛,推之固定,与头皮无粘连,患者无神经功能缺失。CT表现:左侧额骨内外板膨胀,最大层面约3.1cm×2.4cm,其内可见略低密度、斑点状高密度影,相邻脑组织受压(图1A)。CT诊断:左侧额骨占位,考虑良性病变可能性大。MRI表现:左侧额部颅骨见类圆形不均匀长T1长T2信号影,病灶边界清楚,其内见小片状等信号影,病灶相邻左额叶轻度受压。增强扫描病灶边缘见线样、条状强化(图1B、1C)。MRI诊断:左侧额部颅骨良性占位性病变,考虑骨纤维异常增生症。患者行左额颅骨占位切除+     

A contemporary and a historical patient with an ectopic meningioma

Introduction: Ectopic meningiomas are rare tumors which can be encountered by all surgical specialties.

Patients and methods: We report on two different cases, a contemporary one and a historical one, highlighting the diversity of clinical presentations and prognoses of these lesions. Furthermore epidemiological aspects, clinical features, and diagnostic and therapeutic work-up in patients with an ectopic meningioma are reviewed.

Results: Typically, ectopic meningiomas present as gradually expanding lesions, causing a variety of symptoms by their mass effect. Diagnosis is based on histological characteristics, which are similar to those of intracranial meningiomas. Treatment is primarily surgical.

Conclusions: The cases we report are at different ends of the clinical and prognostic spectrum. Therapeutic options for different clinical scenarios are discussed.     

Metastasis in meningioma

Summary Meningioma is a neoplastic growth originating from the leptomeninges. Although meningiomas are usually benign, malignant meningiomas with distant metastases occur infrequently. There is little precise information in the literature regarding the frequency of metastases in meningiomas; their incidence has been vaguely reported to be less than 1 per 1,000. Furthermore, most of the previous studies have also included haemangiopericytomas which most recent authorities do not consider meningiomas. In our experience with the management of 396 meningiomas over the past 18 years, 7 meningiomas were classified as malignant by defined histological criteria. After initially presenting as solitary intracranial neoplasms, three of the malignant meningiomas metastasized to extracranial tissues. Collectively, the metastases involved the vertebral bodies, liver, pelvis, long bones, and the spinal cord. This confers an incidence of metastasis of 0.76% when considering all the meningiomas, and an incidence of approximately 43% when considering only malignant meningioma; both percentages are significantly higher than reported previously. This high incidence of metastasis in the malignant meningioma indicates a worse prognosis than formerly assessed and also characterizes the malignant meningioma as a primary central nervous system neoplasm with one of the highest rates of metastasis. In addition, when malignant meningioma is classified by following strict criteria, the risk of metastasis in the ensuing clinical course can be predicted with a higher reliability.     

显微外科手术治疗镰幕结合处脑膜瘤

目的 探讨镰幕结合处脑膜瘤的临床特点、影像学表现和显微外科手术注意事项。方法 回顾分析１４例镰幕结合处脑膜瘤患者的临床资料。所有患者术前均进行了ＣＴ检查,１０例患者同时进行了ＤＳＡ检查,６例行ＭＲＩ检查,２例行ＭＲＡ检查。１０例行枕下经小脑幕入路,其中７例为病灶侧向上,３例为病灶侧向下,３／４俯卧位;３例行幕下小脑上入路,１例行侧脑室后部入路。结果 １４例中,肿瘤全切除１２例,近全切除２例。术后发     

Aneurysm inside meningioma

Summary The first case in the literature of a large meningioma of the Sylvian fissure incorporating an aneurysm of the middle cerebral artery in a 7-year-old girl is described. The tumour with the aneurysm inside was totally removed. Despite resection of the middle cerebral artery there was complete disappearance of a severe pre-operative neurological deficit. The patient is practically healthy six years after surgery.     

Intraventricular meningioma

Summary Ten patients with histologically verified intraventricular meningiomas were treated between 1974 and 1985. There were eight female and two male patients, ranging in age from 25 to 72 years with a mean age of 45.5 years. Headache and disturbed mentation were the most common presenting symptoms whereas corticospinal disturbance, altered mentation and homonymous hemianopia were the most common signs on formal neurological examiantion. Papilloedema was demonstrable in 50% of cases and evidence of dysphasia was apparent in 60% of patients with lesions affecting their dominant hemisphere. A single instance of drop attack occured in a patient harbouring a third ventricular meningioma.Computed tomography, with and without contrast enhancement, and angiography were employed in all cases and proved highly sensitive and specific for tumour localisation and tissue diagnosis. In addition, angiography proved invaluable in demonstrating both vascular supply and the effects imposed upon the surrounding cerebral vasculature by tumour mass and hydrocephalus. Nine tumours occured in the lateral ventricular trigone of which 5 were left-sided. A tenth tumour was located in the third ventricle.Twelve resections were performed in 10 patients. One patient was found to have a highly malignant cystic meningioma which recurred within 10 weeks of the original surgery and proved fatal shortly thereafter. A second patient whose initial resection was subtotal had a recurrence 3 years postoperatively which was totally resected. Lesions were approached most commonly through the posterior middle or posterior inferior temporal gyri. On 3 occasions a right posterior middle frontal gyrus approach was used and in one case a posterior parieto-occipital cortical incision was employed.Operative mortality was naught. Case mortality was 10% secondary to a highly malignant tumour. Two patients had an excellent result and six patients had a good result. One patient had substantial memory difficulties after removal of a third ventricular tumour via the transfrontal-transventricular approach. Postoperatively one patient required an internalised CSF shunt and another developed small subdural and intraventricular haemorrhages requiring evacuation and external ventricular drainage with good recovery. Pre-existing visual field deficits improved in 2 cases and in one instance a new hemianopic defect was induced by surgery. Homonymous hemianopia was the most common postoperative neurological sign. Mental status and corticospinal signs invariably improved. Two patients required continued anticonvulsant therapy. One patient required intranasal DDAVP as a result of hypothalamic diabetes insipidus which preceded surgery and has not resolved.     

对比分析间变型脑膜瘤与非典型脑膜瘤的MRI特征

目的比较间变型脑膜瘤与非典型脑膜瘤MRI征象。方法回顾性分析经手术病理证实的20例间变型脑膜瘤与30例非典型脑膜瘤的MRI资料,比较两种脑膜瘤的MRI征象。结果间变型脑膜瘤与非典型脑膜瘤相比,肿瘤分叶征、坏死囊变、瘤周水肿及瘤脑界面模糊4项差异均有统计学意义(P均0.05);肿瘤出血、强化均匀性、脑膜尾征及邻近骨质改变4项差异无统计学意义(P均0.05)。结论间变型脑膜瘤与非典型脑膜瘤MRI征象存在差异,有助于鉴别诊断。     

Primary meningioma intimately related to skull: Case report and review of the literature

A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case.     

Intracranial clear-cell meningioma

Intracranial clear-cell meningioma (CCM) is rarely reported in the literature since it has to be distinguished from other subtypes of meningioma. Most of the CCMs are intraspinal, according to the related literature. We report a case of occipital parietal CCM in a 6-year-old child, review all the 35 intracranial CCMs that have been reported since 1995 to present and discuss their clinical, radiological and histopathologic characteristics.     

Straight sinus meningioma

Successful removal of a meningioma arising from the straight sinus is described. The tumor was removed via a combined right occipital craniotomy and suboccipital craniectomy. The occluded straight sinus and an unusual vein draining the Galenic system to the superior sagittal sinus were demonstrated angiographically. Various kinds of visual symptoms appeared after the operation, but these gradually cleared.     

巨大型岩斜脑膜瘤的手术策略

目的探讨巨大型岩斜脑膜瘤的手术策略。方法回顾性分析32例直径超过4.5cm的岩斜脑膜瘤患者手术及预后情况。将患者分为枕下乳突后入路组与颅底外科乙状窦前入路组,对其手术时间、肿瘤切除情况、及术后神经功能损伤情况进行对比研究。结果枕下乳突后入路组肿瘤全切除率及次全切除率分别为43%、36%;乙状窦前入路组分别为39%、22%,两组差异无显著性意义（P＞0.05）,但枕下乳突后入路组患者神经功能后遗症的发生率较乙状窦前入路组低且症状轻,Karnofsky预后评分较高［枕下乳突后入路组为(75±18)分,乙状窦前入路组为(49±26)分］,两组差异有显著性意义(P＜0.01)。结论巨大型岩斜脑膜瘤患者的肿瘤切除情况与手术入路的选择无明显相关性。枕下乳突后入路手术,在不加重神经功能损伤的前提下,应尽量争取肿瘤全切除;如不能全切除,应缩小瘤体≤3cm,以利术后放射外科治疗,可能是较为安全有效的治疗方案。     

Resected atypical meningioma relapsed to anaplastic meningioma during luteinizing hormone-releasing hormone agonist therapy

A 55-year old man with a history of meningioma treated with LHRH-agonist plus radiotherapy for prostate cancer (PCa) experienced a meningioma growth during hormone therapy (HT). Meningioma was radically resected revealing an atypical meningioma and HT was continued due to the high risk of PCa relapse until symptomatic meningioma relapse occurred after further 10 months. Gross lesions were radically removed and histology revealed anaplastic meningioma. This is the first case of rapid meningioma evolution to an anaplastic histology during LHRH-agonist.     

脑膜瘤血管内皮生长因子表达与瘤周水肿及预后的关系

目的 研究血管内皮生长因子(VEGF)表达与脑膜瘤瘤周水肿(PTBE)及肿瘤复发的关系。方法 应用免疫组织化学方法检测34例脑膜瘤、3例正常脑组织中VEGF的表达情况，并与瘤周水肿、是否复发等临床情况相比较。结果正常脑组织中无VEGF表达，32／34例脑膜瘤有阳性表达，VEGF平均表达强度为1．91。VEGF表达为O的2例，平均水肿指数为O．75；VEGF表达为1的9例，平均水肿指数为l_38；VEGF。表达为2的13例，平均水肿指数为1．97；VEGF表达为3的10例，平均水肿指数为2．39；VEGF表达水平越高，瘤周水肿越明显。复发组VEGF表达(2．43)明显高于非复发组(1．55)。结论 VEGF过表达在脑膜瘤瘤周水肿的形成和肿瘤复发中起重要作用，对脑膜瘤患者预后的评估及合适治疗方案的选择有指导意义。     

Mixed teratoma and meningioma in the temporoparietal region

A case of a teratoma mixed with meningioma in the left temporoparietal region in a patient with progressive memory impairment, bradyphasia, loss of visual acuity of the left eye, and left leg weakness is presented. Histological findings showed fibroadipose tissue containing gland-like structures and lymphocytoid cells alongside a meningothelial meningioma. It is unusual for a teratoma to occur in the temporoparietal region; even more unusual is its proximity to an unrelated tumor in the same location.     

Giant meningioma in a fourteen-month-old infant

A case of giant meningioma in a 14-month-old infant is presented and pathologic characteristics of such lesions are reviewed.     

Extramedullary hematopoeisis within a convexity meningioma

BACKGROUND: Hematopoiesis outside the bone marrow is known to occur in patients with severe anemia, leukemia, polycythemia, or myelofibrosis, and in patients affected by chronic poisoning by marrow-toxic substances. CASE DESCRIPTION: A 66-year-old right-handed man complained of 4 days of terrible right-sided, sharp, and shooting headache for which he saw his primary care provider. Routine laboratory examination showed a WBC count of 30800/microL. Neuroimaging showed a large, right frontotemporal, extra-axial, heterogeneously enhancing, dural based mass with associated recent intramural hemorrhage with evidence of midline shift and uncal herniation. The mass was resected using a right-sided extended craniotomy with anterior fossa and middle fossa approach. A hematoxylin-eosin-stained biopsy specimen showed whorls of tumor cells, diagnostic of a meningioma. Interspersed within the tumor bulk were nucleated RBCs, representing areas of extramedullary erythropoiesis within a meningioma. Flow cytometric evaluation confirmed the clinical suspicion of an underlying chronic lymphocytic leukemia. CONCLUSION: Occurrence of extramedullary hematopoiesis within a meningioma is extremely rare. Various theories may explain the occurrence of extramedullary hematopoiesis occurring within a meningioma in our patient, such as hematopoietic differentiation of multipotent mesenchymal tumor cells; direct extension of hematopoietic activity from the neighboring marrow cavity; displacement from bone marrow of stem cells that settle and develop in tissues where capillaries and blood vessels proliferate, such as a meningioma; or congenital heterotopia of totipotent connective tissue cells, which, under certain circumstances, may transform into hematopoietic tissue.     

脊索样脑膜瘤的影像学表现

目的探讨脊索样脑膜瘤的影像学表现。方法回顾性分析6例经手术病理证实的脊索样脑膜瘤患者的CT和MRI。6例中4例接受CT,其中2例接受CT平扫和增强扫描,1例仅接受平扫、1例仅接受增强扫描;5例接受MR平扫及增强扫描,其中2例接受动态增强MRA检查。结果 4例病灶位于幕上,1例位于幕下桥小脑角区,1例跨小脑幕上下生长。3例侵犯邻近组织。3例伴瘤周水肿。3例病灶CT平扫分别呈低、等、高密度;5例病灶平扫MR T1WI均呈低信号,T2WI 4例呈高信号。4例MR增强检查中病灶明显强化,3例见脑膜尾征。2例MRA动脉期肿瘤均未见显影,其中1例静脉期肿瘤显影,1例MRA全程未见显影。结论脊索样脑膜瘤女性多见,发病年龄较轻;肿瘤好发于幕上,T2WI呈高信号;增强后强化明显,且呈延迟强化;易侵袭邻近组织,尤其是骨组织,但较少突破软脑膜侵袭脑实质。