Intraosseous Meningioma Research Articles

Preoperative Planning of Craniectomy and Reconstruction using 3D Printed Cranioplasty for Treatment of Calvarial Lesion

There is a number of diseases which causes calvarial lesion. Fibrous dysplasia, intraosseous meningioma, osteoma is to name a few. Treatment of these lesions necessitates removal of part of the skull or craniectomy to decompress the brain and neural elements. The ensuing skull defect needs to be repaired to protect the brain. Previously used allograft and alloplastic materials have been replaced with newer PEEK material, which is more resistant, biocompatible and can be 3D printed. In this series we describe 4 cases in which skull lesions are removed and reconstructed in the same sitting using 3D printed PEEK implant designed preoperatively using high resolution CT data. The results are superior and complication rates are low. All the cases were done in different government hospitals. The technical process was developed indigenously, and the methods are the first in our country. Bang. J Neurosurgery 2024; 13(2): 64-69

Preoperative planning of craniectomy and reconstruction using three-dimension-printed cranioplasty for treatment of calvarial lesion.

Common calvarial lesions include fibrous dysplasia (FD), intraosseous meningioma, osteoma, Langerhans cell histiocytosis (LCH), intraosseous hemangioma, dermoid and epidermoid cyst, and malignancy. Surgical removal with removal of the involved skull is the choice of treatment for these lesions. Previously, the skull defect was repaired using allograft, and alloplastic materials have been replaced with newer polyetheretherketone (PEEK) material, which is more resistant, biocompatible, and can be 3-dimension (3D)--printed. High-resolution 3D printing uses very fine extruders to put materials in fine layers to recreate patients' anatomy authentically, which gives superior cosmetic outcomes. Our objectives were preoperative planning of craniectomy and reconstruction for calvarial lesions and reconstruction of skull defects using 3D-printed cranioplasty with PEEK materials. In this series, we describe 11 cases in which skull lesions were removed and reconstructed in the same sitting using a 3D-printed PEEK implant designed preoperatively using high-resolution computer tomography. All the cases were done in the neurosurgery department of Bangabandhu Sheikh Mujib Medical University from 2021 to 2023. Patients were followed up for 6 months after surgery. Regarding 11 cases, six cases were FD, three cases were intraosseous meningioma, one case was intraosseous hemangioma, and one case was LCH. Average lesion size were 12.73-5.77 cm. Cranioplasty was done with PEEK material. Minor complications were treated conservatively. Seroma, postoperative fever, and nausea were among these. The human bone-like biocompatibility and resistance to physical forces leads to more frequent use of PEEK, which enables to repair of complex craniofacial defects with better cosmesis. Despite some limitations, the PEEK cranioplasty implant continued to thrive and showed its promise to be an excellent material. Further, research and investment should be put into developing the technique.

A Case Report of a Rare Subset of Meningiomas: Intraosseous Meningioma

Meningiomas are the most common central nervous system neoplasms and occur most frequently along the dural folds and cerebral convexities. While meningiomas are slow growing and typically do not invade brain parenchyma they are of clinical importance as they can impinge surrounding structure causing a variety of signs and symptoms depending on size and location. We report here a rare subgroup of extradural meningiomas that emerge from the calvaria, a primary intraosseous meningioma, found during cadaveric dissection in a graduate anatomy course in the Department of Physician Assistant Studies at Samford University.

Exophthalmos Revealing a Spheno Temporo Orbital Meningioma

Intracranial meningiomas are usually non-cancerous tumors that develop from arachnoid cells in the meningeal envelope. However, there are rare forms called intraosseous meningiomas, which present unique challenges for diagnosis and treatment. In this report, we describe a rare case of a giant sphenotemporal meningioma in a 72-year-old male with diabetes. The patient experienced progressive exophthalmos and visual impairment over a period of five months. Radiological imaging confirmed the diagnosis, showing extensive infiltration into the infra-temporal region. Histopathological examination confirmed a plaque-type meningothelial meningioma. The patient underwent surgical management, which involved maxillofacial surgery. Intraosseous meningiomas are rare but are increasingly being recognized, accounting for about two percent of all meningiomas. The spheno-orbital region is a common site for these tumors. Histologically, there are various subtypes, with meningothelial meningioma being the most common. The differential diagnosis includes Paget’s disease and osteomas. The optimal treatment approach involves extensive surgical resection, followed by adjuvant radiotherapy for any remaining or symptomatic tumors. The prognosis depends on the extent of resection and tumor progression, underscoring the importance of regular monitoring. Early intervention is crucial to preserve visual function and achieve favorable outcomes.

Sphenoid intraosseous meningioma associated with monostotic hyperostosis “a diagnostic challenge”: case report

Sphenoidal intraosseous meningioma is included within the extradural brain tumors which constitute less than 2% of the total meningiomas. We describe the case of a 39-year-old female patient who presented with symptoms typical of the location of this lesion, was taken to resection of the lesion, where later was diagnosed by biopsy and immunohistochemistry of sphenoid intraosseous meningioma associated with monostotic hyperostosis, the importance of this case lies in a timely recognition of sphenoid intraosseous meningioma, as its epidemiological, clinical, radiological and differential considerations of other entities present in chronic headaches

Virtual Surgical Planning and Customized CAD/CAM Cranial Implants: Preoperative and Intraoperative Strategies for Temporal Intraosseous Meningioma Resection.

Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas, with the indication for surgical resection in most cases. With an increasing demand for efficient workflows with optimal functional and cosmetical results, techniques for bone reconstruction after resection are developing rapidly. The authors present 2 cases with one-stage cranioplasty after resection of PIM, using 3D technology for preplanned patient-specific implants. In the first case, a premanufactured patient-specific PEEK implant was used for reconstruction; in the second case, a 3-dimensional (3D)-based premanufactured silicon mold was used to produce a customized PMMA implant intraoperatively. Both techniques enabled the surgeons to achieve optimal intraoperative fit of the implant after craniectomy, leading to satisfying functional and cosmetic results. The use of 3D technology, such as Computer-Aided Design and Computer-Aided Manufacturing (CAD/CAM) for the production of patient-specific implants can optimize 1-stage cranioplasty after PIM resection.

Association of imaging classification and histopathological grading in primary intraosseous meningioma of the skull

BackgroundPrimary intraosseous meningioma of the skull (PIMS) is a rare type of primary extradural meningioma (PEM) involving cranial bone. The existing literature strongly suggest the importance of radiological feacures in pathological diagnosis of PIMS. Thereby, the aim of this study is to investigate the association between imaging classification and histopathological grading in PIMS. MethodsIn this retrospective study, we retrospectively analyzed the computed tomography scan/magnetic resonance imaging and pathological data pertaining to patients with pathologically proven PIMS. The association between radiological features, imaging classification, and histopathological grading was analyzed using logistic regression analysis. ResultsIn this study, data of 25 patients with PIMS were assessed. The univariate logistic regression analysis results showed significant correlation between histopathological grading and imaging classification (OR: 22.5; 95% CI: 2.552–198.378; p = 0.005), intra- and extracalvarial extension (OR: 7.2; 95% CI: 1.066–48.639; p = 0.043), and tumor margin (OR: 7.19; 95% CI: 1.06–47.61; p = 0.043). According to the results of multivariate logistic regression analysis, imaging classification was the strongest independent risk factor for high-grade PIMS, and the risk of aggressiveness of osteoblastic type of PIMS was 16.664 times higher than that of osteolytic type of PIMS (OR: 16.664; 95% CI: 1.15–241.508; p = 0.039). ConclusionsImaging classification is an independent risk factor for high-grade PIMS.

Intraosseous meningioma of the orbital roof

Primary intraosseous meningioma is a rare variety of meningioma that represents about 1% of all meningiomas Intraosseous or intradiploic meningioma of the pediatric orbital roof is reported in case reports in very isolation.. The following article is carried out with the objective of describing a case of primary intraosseous meningioma of orbital roof in a pediatric patient as well as reviewing the literature in this regard. It was concluded that intraosseous or intradiploic meningioma of the orbital roof is a rare entity. They are more frequent in males and the common age of presentation is at the beginning of the second decade of life. They usually only present with ipsilateral proptosis, without impaired visual acuity or pain. Most are histologically of the psammomatous variety and the treatment of choice is total surgical excision.

Imaging Features of Primary Intraosseous Meningiomas.

To describe the imaging features of primary intraosseous meningiomas (PIMs) to aid an accurate diagnosis. Clinical materials and radiological data for 9 patients with pathologically confirmed PIMs were reviewed comprehensively. Most lesions involved inner and outer plates of the calvaria and all were relatively well circumscribed. Upon computed tomography, portions of the solid neoplasm were hyperattenuated or isoattenuated. Hyperostosis was found in many lesions, but calcification was seen rarely. On magnetic resonance imaging, most neoplasms were hypointense on T1-weighted images, hyperintense on T2-weighted images, and heterogeneous on fluid-attenuated inversion recovery images. In most cases, the soft tissue of neoplasms showed hyperintense on diffusion-weighted imaging and hypointense on apparent diffusion coefficient. All lesions were obviously enhanced after gadolinium administration. Each patient accepted surgical treatment and recurrence was not observed during follow-up. Primary intraosseous meningiomas are very rare tumors that occur usually in later life. They are well-defined and tend to involve the inner and outer plates of the calvaria, with a classic appearance of hyperostosis on computed tomography. Primary intraosseous meningiomas display hypointense on T1-weighted images, hyperintense on T2-weighted images, and hyperattenuated or isoattenuated on computed tomography. Hyperintense on diffusion-weighted imaging, hypointense on apparent diffusion coefficient can also be found. Obvious enhancement supplied additional information for an accurate diagnosis. A neoplasm with these features should raise the suspicion of a PIM.

Osteoblastoma of the temporal bone – A familiar tumour at an uncommon site

Osteoblastoma is a benign bone tumour arising from the non-odontogenic epithelium. This tumour predominantly affects the vertebral column and long tubular bones such as the femur and tibia. Herein, we report a case of Osteoblastoma affecting temporal bone. Radiologically, it was thought to be an intraosseous meningioma, hemangioma, or eosinophilic granuloma. Histopathological examination of the tumour showed woven bone arranged in sheets and micro trabecular array, rimmed by a single layer of osteoblast, surrounded by lamellar bone. Intertrabecular spaces were composed of richly vascular fibrotic stroma, consistent with the diagnosis of osteoblastoma.

Frontotemporal Intradiploic Meningioma with Progressive Intraorbital Invasion: Case Report

Meningiomas are the most common primary brain tumors, Orbital invasion usually invades as an extension of the sphenoid wing meningiomas. We report the case of a 54-year-old man who presented with frontotemporal intraosseous meningioma with intraorbital invasion.

Surgical Resection of Large Primary Intraosseous Meningiomas (6 Case Reports)

The clinical features and surgical techniques related to patients undergoing resection of extracranial large primary intraosseous meningiomas are studied. The clinical characteristics, treatment, and prognosis of 6 patients with primary intraosseous meningiomas larger than 5cm in diameter were retrospectively reviewed in the 10th Neurosurgical Department of Beijing Tiantan Hospital, Capital Medical University. Five males and one female (18-57years old) suffered from large primary intraosseous meningiomas. The main symptoms were headaches accompanied by head swelling. CT showed irregular thickening of the bone diploe with increased density and uneven surface. MRI showed partial bone destruction of the skull, local thickening of the internal and external plates, shell and palisade changes of the external cranial plate, and enhancement of the adjacent meninges. A horseshoe or coronary incision plus the "Mercedes-Benz" incision were chosen to expose the skull bone, and drilling was performed in the normal skull bone at the transition zone between abnormal and normal skull bone. After drilling, the sub flap dura was dissected, the hyperplastic skull was dissected with a milling cutter, and the residual tumor was then resected. A cranioplasty was performed 6months to 1year later. Surgical treatment and precise perioperative management can achieve a better prognosis for large intraosseous meningiomas.

Cranial meningioma with bone involvement: surgical strategies and clinical considerations

BackgroundIntracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.MethodsA single-centre, retrospective cohort study (January 2010–August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.ResultsThirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary ‘on-table’ cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).ConclusionMeningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.

Using 68 Ga-DOTATATE PET for Postoperative Radiosurgery and Radiotherapy Planning in Patients With Meningioma: A Case Series.

For patients with either an incompletely resected meningioma or recurrence after surgery, stereotactic radiosurgery is frequently used. MRI is typically used for stereotactic radiosurgery targeting, but differentiating tumor growth from postoperative change can be challenging. 68 Ga-DOTATATE, a positron emission tomography (PET) radiotracer targeting the somatostatin receptor type 2, has been shown to be a reliable meningioma biomarker. To evaluate the impact of 68 Ga-DOTATATE on treatment planning in patients who had previously undergone meningioma resection. We present a consecutive case series of 12 patients with pathology-proven meningioma who received a 68 Ga-DOTATATE PET between April 2019 and April 2021. Treatment planning was performed first using MRI. DOTATATE-PET images were then used to assess accurate tumor identification. Ten patients had WHO Grade 2 meningioma, and 2 patients had Grade 1 tumor. Eight patients had recurrent meningiomas, and 4 patients had newly diagnosed disease. Overall, 68 Ga-DOTATATE PET scans altered previously formulated treatment plans in 5 of 12 patients. In addition, 9 of 12 patients had disease foci not appreciated on MRI. In this series, incorporating 68 Ga-DOTATATE PET imaging had clinical utility for most patients in whom it was used. It proved particularly adept in demonstrating intraosseous meningiomas, differentiating recurrence from postoperative changes, and identifying subcentimeter disease foci. It is an imaging modality that our center will continue to use as a means of improving postoperative treatment plans after the surgical resection of meningiomas.

Intraosseous meningioma, a rare presentation of a common brain tumor: illustrative case.

BACKGROUNDThe subset of extradural meningiomas arising from bone is called primary intraosseous meningioma. The present article outlines the clinical presentation, investigation, surgical management, and clinical outcomes of a challenging case of intraosseous meningioma.OBSERVATIONSA 27-year-old male presented with new-onset seizure of 3 years’ duration and growing painless hard swelling involving the left frontoparietal bone, the medial aspect of the left orbit, the nasal bone, and the temporal bone. Brain computed tomography showed a diffuse intradiploic space osseous lesion with a ground-glass appearance. The patient underwent bifrontal craniotomy and tumor excision. The histopathological sections showed the presence of classic whorls of meningothelial cells around reactive bony tissue suggestive of intraosseous meningioma. Postoperatively, the patient was neurologically intact, and he was discharged in a stable condition. The outcome of this case was satisfactory.LESSONSThe treatment of primary intraosseous meningioma is wide surgical excision together with the involved dura and any intradural tumor. The location of the tumor determines the approach and the amount of resection, keeping in mind preservation of function. The use of adjuvant therapy is reserved for cases of tumor recurrence or an atypical type.

Intradiploic meningioma

Intradiploic meningioma is a rare subtype of primary intraosseous meningiomas. The convexity and the skull base are the two primary locations for intraosseous meningiomas. They usually present as a painless expansile mass without any neurological findings. Intradipoic meningiomas are seldom correctly diagnosed preoperatively and are usually mistaken for primary bone tumours. CT scan head with bone windows and contrast-enhanced MRI brain should be done for diagnosis and evaluation. Intraosseous meningioma should be considered in the differential diagnosis of patients presenting with osteoblastic or osteolytic skull lesions as the treatment of choice is resection, which is potentially curative.

Correlation of findings of CT and MRI in skull lesions

Introduction: Skull vault lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Calvarial lesions may arise from skull bones or can be secondary to invasion of skull vault from brain or scalp based lesions. Objectives: The aim of this study is to study the role of CT and MRI in evaluating skull vault lesions. Material and methods: 50 patients with skull vault lesions were considered in our study.The patients underwent CT and MRI scans of head. Results: Among 50 patients, most common skull vault lesions were Skull metastases, osteoma and epidermoid cyst. Chordoma, osseous hemangioma and intraosseous meningioma were the least encountered lesions. Conclusion: This article has demonstrated that CT and MRI have complementary roles in determining the nature of skull lesions. CT is the most accurate method for evaluating bone destruction of the inner and outer tables while MRI is best to assess marrow involvement, soft tissue component and invasion of adjacent tissues.

Atypical presentation of the World Health Organization Grade 1 meningioma: A case report

Meningiomas are the most common benign neoplasm of the brain whereas ectopic presentation, although reported, is rare. Among these ectopic tumors, there are a group of purely intraosseous meningiomas, which usually are diagnosed differentially from common primary osseous tumor such as fibrous dysplasia and osteoid osteoma. The World Health Organization (WHO) Grade 1 meningioma with an involvement of scalp, calvarial bone, dura, and brain seen rarely. This type of atypical presentation of the WHO Grade 1 meningioma rarely documented. The main theories to justify the unusual topography appear to be embryological remains of neuroectodermal tissue or cellular dedifferentiation. Surgical treatment seems the best curative option. Meningioma with bony involvement could be very aggressive tumor, need to prepare accordingly for surgery.

Bony Calvarial and Skull Base Tumors

The calvaria or skull vault, in general, has a limited spectrum of oncological disorders which are both unique to it and ubiquitous throughout the body. Lesions of the calvarium may originate from the bony structures or may be secondary to an invasion of scalp-based lesions or brain-based lesions into the skull vault. A PubMed/Medline search was conducted using the MESH keywords “Calvarial tumors”, “Bony tumors”, “Skull base bony lesions” and all reported cases and series were collected, and relevant details extracted from the same. Data were extracted concerning the type of study, the number of cases, follow-up duration, the primary treatment offered, details of adjuvant therapy, overall survival, and recurrence rates where relevant. All data were then tabulated and reviewed. Cases showing relevant information on treatment modalities and their effect on outcomes and survival were only included. A total of 1020 results were found on the PubMed database (until March 2021) and after duplicates removal, a total of 9 studies were found to be relevant for calvarial tumors with 1 case series and 4 retrospective reviews of intraosseous meningiomas which included 2 review papers as well. Most of these results were either retrospective case series or case reports along with a single systematic review of intraosseous meningioma. The primary treatment modality in almost all cases was either surgery or biopsy followed by adjuvant radiotherapy. The skull base and cranial vault is a Pandora's box of malignancies with varied shapes and appearances. Presentation is either due to pressure symptoms or swellings, and whenever accessible, complete excision offers the best management. Imaging findings are of germinal importance and help differentiate lesions, which often decides management. When in doubt, a biopsy may offer the best solution. Bony reconstruction and adjuvant therapy with close follow-up often decide prognosis.

Primary intraosseous meningioma of the vertebra: illustrative case

BACKGROUNDPrimary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae.OBSERVATIONSA 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors’ institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2.LESSONSThe authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.