Primary intradiploic meningioma in the pediatric age-group

Calvarial angiomatous meningioma developed in the diploe

Background:

Angiomatous meningioma is a rare subtype of meningiomas. To the best of our knowledge, there have been no reports of intradiploic angiomatous meningioma.

Case Description:

A 53-year-old previously healthy woman was diagnosed with a calvarial lesion during a brain checkup. Cerebral magnetic resonance imaging showed an intradiploic tumor, 11 × 14 × 12 mm, in the right parietal bone. It was an enhancing, lobular tumor presenting as isointensity on T1- and hyperintensity on T2-weighted sequences, with an intense enhancement of the adjacent dura mater. Computed tomography revealed bone erosion at the tumor site, extending predominantly into the inner side, and sclerotic changes in the surrounding bone. Total resection was performed. Microscopically, the tumor tissue comprised cells with low-grade meningioma and intervening prominent vasculatures, consistent with angiomatous meningioma.

Conclusion:

Angiomatous meningioma should be considered as a differential diagnosis when an intradiploic tumor shows a lobular structure, intense enhancement of the adjacent dura mater, and sclerotic changes in the surrounding skull. These findings can support prompt tumor resection.

Fronto-orbito-ethmoidal intradiploic meningiomas: A case study with systematic review

Background

Primary intradiploic meningiomas, extra-axial tumors arising primarily in the skull, are rare. The authors reported a complex case of intradiploic intraosseous metaplastic meningioma of the left medial wall and orbital roof with the left frontal sinus invasion and left ethmoidal body bone substitution. The authors also conducted a systematic review concerning diagnosis and management of patients affected by purely calvarial intradiploic meningiomas along with a focus on fronto-orbito-ethmoidal ones.

Methods

A literature search was conducted using PubMed and Scopus databases according to preferred reporting items for systematic reviews and meta-analysis statement and with the following Mesh terms: Intradiploic, intraosseous, calvarial, and meningioma. Eligibility criteria were limited by the nature of existing literature on intradiploic meningiomas, consisting of only case series, and case reports.

Results

A total of 128 published studies were identified through our search. 41 studies were included in this systematic review, 59 patients with a female/male ratio of 1.2/1. The mean age of the patients is of 47.69 years (range 3-84 years). Only seven out of 59 patients (11.9%) presented a complex intradiploic meningioma located in fronto-orbito-ethmoidal region like our case. In almost all patients, a gross-total resection was performed (96.6%) and only in two patients (3.4%) a subtotal resection was achieved.

Conclusion

The authors shared this successfully treated case to add to the overall clinical experience in the management of this rare subtype tumor, with the hope that more studies are conducted to further address the mechanism of intradiploic meningiomas development.

Primary Extradural Meningioma of Posterior Fossa Associated with Acquired Chiari Malformation: A Short Review

Generally, meningioma is considered intracranial lesion occurring in the intradural compartment. However, meningioma can also occur and usually confined in the extradural compartment called as primary extradural meningioma (PEM). PEM represents a special subgroup of meningioma constitute about 1% of all meningioma. PEM arises outside the subdural compartment and usually contains neither connection underlying subdural structures nor extends into with subdural compartment. It is commonly located in the paranasal sinus, middle ear, rarely in the intradiploic spaces of calvarial bone such as temporal, frontal, and parietal bone and orbit but extremely uncommonly in the occipital and sphenoid bones. Authors did detailed Pubmed search for posterior fossa, occipital bone extradural, ectopic intraosseous meningioma which yielded only four publications in the form of isolated case report analyzing only five case of PEM. Authors report a rare case extradural meningioma in a 40-year-old male, who presented with progressive headache and gait imbalance. Magnetic resonance imaging study of brain revealed the presence of PEM of posterior fossa associated with acquired Chiari malformation. The patient was managed successfully surgically with excision of meningioma and release of associated acquired tonsiallar descent was carried out. Authors are analyzing total of five cases including four cases from published literature and one our current case. PEM of the posterior fossa tends to have equal predilection in male and female (3:3), with a mean age of 48 years (range 25-64 years). All cases were surgically and underwent gross total surgical excision. The clinical features, imagings, and management of this rare entity along with the pertinent literature are briefly discussed.

Skull Vault Lesions: A Review

OBJECTIVE

The aim of this article is to describe the imaging features of the most common benign or malignant skull vault lesions, which may be focal, multifocal, or diffuse.

CONCLUSION

Imaging features, in association with the age, history, and clinical symptoms of the patient, make it possible to propose a course of action: simple survey, pathologic confirmation, or complete surgical resection.

Primary extradural meningiomas in head: a report of 19 cases and review of literature

Primary extradural meningiomas (PEMs) in head were rare tumors. Here we analyzed 231 cases of PEMs in head (including our 19 cases) reported in the literature during the CT era. We found that PEMs in head accounted for 0.8%-1.8% of all meningiomas. The constituent ratio of male PEMs in head increases markedly. PEMs in head have bimodal distribution of ages. The most common presenting symptom was a mass in the region of the lesion. The average duration of symptom was 2.38 years. The skull convexities, paranasal sinuse and nasal cavity, and middle ear ranked as the top three of all sites of tumors. The most common type was Type II (calvarial or diploic). Among 231 cases, total, subtotal and partial removals of tumors were achieved in 89%, 5.5% and 3.1% respectively, and no death occurred perioperatively in all patients. 90% were benign, 5.6% atypical and 3.9% malignant in the 231 cases. The most common histopathological subtype was meningothelial meningioma. The recurrence and tumor-related death rates were 22.4% and 8.2% respectively during a mean 3.03-year follow-up. Our results demonstrate that PEMs in head have some marked clinical characteristics compared with primary intradural meningiomas. Total tumor removal together with a wide excision of all involved tissues followed by the reconstruction of tissue defects is the best surgical project. The prognoses are good in the benign cases after complete surgical resections.

Orbital roof intradiploic meningioma in a 16-year-old girl

Primary intraosseous or ectopic meningioma of the skull is a rare tumor accounting for about 1% of meningioma. Intradiploic meningioma is an extremely rare type of extraneuraxial meningiomas. Intradiploic meningioma of the orbit is extremely rare, and <8 such cases are reported till date in western literature occurring in the pediatric age group. Here the authors present a case of 16-year-old female, who presented with progressive proptosis, with normal vision and was managed successfully surgically. Clinical features, pathophysiology, and surgical management of this rare entity are discussed in the context of pertinent literature.