Abstract
Meningiomas are primary intracranial tumors derived from arachnoid cap cells or meningothelial cells and usually display dural attachment. However, a small proportion of meningiomas that arise from the Sylvian fissure do not manifest dural attachment. Sylvian fissure meningiomas are relatively rare and have differential characteristics as compared with typical meningiomas. Herein, we reported a special case of atypical meningioma in the Sylvian fissure, that showed non-enhancement after contract management. The patient was a 30-year-old woman with a 2-year history of seizures. Preoperative computerized tomography and magnetic resonance imaging scans showed a calcific, non-enhancing lesion in the right insula lobe. The lesion was excised surgically for seizure control. Intraoperatively, the tumor was observed to be closely adhered to the middle cerebral artery (MCA), resulting in mild arterial damage. A case of Sylvian fissure meningioma was ultimately diagnosed by histopathological examination of the resected specimens. Sylvian fissure meningiomas are closely associated with the MCA and exhibit unusual imaging characteristics. Preoperative misdiagnosis may have serious adverse consequences and may result in incorrect surgery. To improve awareness of Sylvian fissure meningiomas on the differential diagnosis of Sylvian fissure lesions among clinicians, we present this report and briefly summarize previously reported cases to describe the clinical, pathological, radiological, and surgical features.
Highlights
Meningiomas originate from the dura mater; some cases originate from the Sylvian fissure and show non-dural attachment
Our patient presents an additional case of Sylvian fissure meningioma with unusual imaging characteristics and a rare atypical subtype
Presence of brain invasion, which was added to the histological criteria, alone can aid the diagnosis of atypical meningiomas according to the 2016 World Health Organization (WHO) classification of central nervous system tumors (CNST) [38]
Summary
Meningiomas originate from the dura mater; some cases originate from the Sylvian fissure and show non-dural attachment. We describe a patient who presented with an intracranial mass in the right insula lobe, which was clinically diagnosed as a low-grade glioma based on the results of preoperative neuroimaging, with a subsequent revised diagnosis of meningioma confirmed by postoperative histopathology. Low-grade glioma, including oligodendroglioma, and diffuse astrocytoma, was suspected With this provisional diagnosis, the patient was referred for surgical management and underwent a right temporal craniotomy for gross total resection of the tumor and for seizure control. Upon opening the dura and separating the Sylvian fissure, a gray-white lesion (diameter, about 25∗20 mm) was observed It had a relatively elastic consistency and the mass partially invading the brain parenchyma of the insula, was FIGURE 1 | (A) The Computed tomography demonstrated the calcification in right Sylvian fissure and posterior part of insula. An MRI scan will be performed annually to continuously monitor for any evidence of tumor recurrence
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