Intraosseous Meningioma Research Articles

Primary intraosseous meningioma of the calvaria: analysis of the literature and case report

Meningiomas are the most common of the benign intracranial neoplasms. They are uncommon as primary or secondary extracranial entities. Of these, the primary intraosseous variant may represent the rarest form. We report the case of a rare primary intraosseous meningioma presenting as a localized, symptom-free supraorbital bony expansion in an 81-year-old female patient and tabulate the previously reported cases of primary intraosseous meningiomas of the craniomaxillofacial region for analysis.

Intra-osseous meningioma of the orbit: an unusual presentation (2007: 5b)

Primary calvarial or intra-osseous meningiomas are uncommon lesions often confused preoperatively with other primary or secondary bone tumors of the skull. We present details of a patient with a primary calvarial meningioma involving the frontal, zygomatic, sphenoid and temporal bones that was radiographically diagnosed as fibrous dysplasia and initially treated conservatively for many years. Progressive vision loss and significant proptosis, with difficulty of eye closure, prompted surgical removal with cranioplasty and a 3D reconstructed prosthetic flap. Histological examination revealed intra-osseous meningioma. The clinical and radiological findings of intra-osseous meningiomas are discussed, together with a review of the literature.

Sphenoclival Intraosseus Lipoma: Case Report and Literature Review

To present the case of a rare tumor in the sphenoidoclival area and discuss potential pitfalls in diagnosis and management. Case report with literature review. Tertiary referral center. Our patient presented with headache, vertigo, vision problems, and feeling of pressure in the central segment of the face. MR and CT showed a lesion in the body of the sphenoid, with signs of bone destruction and irregular borders. Differential diagnosis included intraosseous meningioma, chordoma, and inflammatory process. Endoscopic/microscopic transnasal approach was performed to reach clival bone and to biopsy the tumor. Histopathological examination showed intraosseous lipoma. Intraosseous lipoma is a rare tumor, or more accurately a hamartoma, and is usually found in the calcaneus or in the proximal femur. It is even rarer in the skull base. Usually it does not present any symptoms and is an incidental finding during imaging for other symptoms. As a rule it runs an indolent course and does not require any treatment. Since no definitive diagnosis can be made only on the basis of imaging (CT and MRI), it requires an open biopsy that if possible should be made in accordance with the principles of minimally invasive surgery.

Metastatic meningioma to the eleventh dorsal vertebral body: total en bloc spondylectomy. Case report and review of the literature

One in every thousand intracranial meningiomas metastatize extracranially. Lung and intraabdominal organs are most frequently affected. Only 7% involve vertebrae and just a dozen cases have been reported in the literature. To our knowledge, this is the first description of a total en bloc spondylectomy through a posterior approach for the treatment of an intraosseous metastatic meningioma to the eleventh dorsal vertebra. In March 1996, a 37 year-old male underwent surgical resection for a left occipital intraventricular benign meningioma (WHO I). He was reoperated in February 2002 due to local recurrence. By the end on 2003 he developed progressively invalidating dorsolumbar pain. MRI studies revealed a T11 intraosseous mass. In March 2004, a percutaneous biopsy and vertebroplasty were performed. The pathological specimen was identified as adenocarcinoma and he initiated chemotherapy. Advice from a second pathologist was seeked, who suggested the diagnosis of intraosseous meningioma. Workup studies failed to reveal any primary tumor. In May 2004 the patient was admitted to our department and a new transpedicular biopsy confirmed the diagnosis. In June 2004 he underwent T11 total en bloc spondylectomy (Tomita's procedure), fusion with bone and calcium substitute-filled stackable carbon-fiber cages, and T9 to L1 transpedicular screw fixation. No postoperative complications ocurred and he is, so far, free from primary and secondary disease. Definite pathology: benign meningioma (WHO I). Distant metastases from intracranial meningiomas are rare entities, arising from benign lesions in, at least, 60% of cases. Enam et al proposed a specific pathological score to differentiate benign, atypic and malignant meningiomas. Such score correlates with the chance of metastatizing: more than 40% in malignant meningiomas compared to 3.8% of brain tumors overall. The ability to metastatize seems to be linked to vascular or lifatic invasiveness. Metastases ocurr more frequently in angioblastic, papillary and meningothelial variants. Hematogenous (especially venous; Batson's perivertebral plexus), linfatic and cerebrospinal fluid are the main routes involved in the spreading of the tumor. Craniotomy itself may also play a role, for the majority of patients have been previously operated on repeatedly. The interval between the onset of the intracranial disease and the appearance of the metastasis varies from months to many years. The value of transpedicular biopsy is widely recognized (efficacy over 80%) and the suitability of the specimen for pathological examination improves when wide inner caliber trephines are used. In the case presented we applied the oncologic concept of vertebral en bloc resection. We believe this case represents a paradigmatic indication of this technique because it respects the concepts of radical resection and spinal stability, and offers an opportunity for the curation of the disease.

Méningiome intra-osseux de la voûte du crâne : confrontation anatomo-radiologique

Intraosseous meningiomas are rare ectopic meningiomas. The authors report the case of a hyperostotic intraosseous meningioma of the parietal bone without dural extension. The preoperative imaging findings, as well as imaging features of the surgical specimen and pathologic findings are discussed.

Primary Intraosseous Meningioma: A Case Report

Primary intraosseous meningioma of the skull is an uncommon disease. It accounts for 0.5 to 1 percent of all meningiomas and is often confused with primary bone tumor of the skull. We report a case of a 77-year-old Taiwanese women with a rare primary intraosseous meningioma. The tumor was located in the right frontoparietal region, involving the coronal suture. The tumor was excised completely. The final pathological diagnosis determined that the tumor was a meningioma. Several cases reported in the past literature are reviewed and the possible pathogenesis of the tumor is discussed.

多房性でosteolyticな画像所見を呈したintraosseous meningiomaの1例

多房性でosteolyticな画像所見を呈したintraosseous meningiomaの1例

Primary intraosseous meningioma in a skull of the medieval period of Southwestern Germany

AbstractPrimary intraosseous calvarial meningiomas are very rare entities in recent times. We present the first case in antiquity of a primary intraosseous meningioma in the frontoparietal bone associated with the coronal suture, and discuss its pathology. The skull derives from southwestern Germany and is dated to the 12th–14th centuries AD. The lesion is interpreted as a solitary osteoblastic neoplasm with hyperostosis on the outside, and osteolysis and radial spiculation in the central part of the lesion with an area of irregularity along the inner table. In cases of solitary osteoblastic skull lesions the differential diagnosis comprises: fibrous dysplasia, osteoma, osteoblastic metastasis, Pagets disease and meningioma with sheet‐like growth along the dural surface with marked hyperostosis (called meningioma en plaque). We believe that a differentiation between hyperostotic meningioma en plaque and intraosseous meningioma cannot be made in skulls from antiquity. Copyright © 2002 John Wiley & Sons, Ltd.

Primary intraosseous meningiomas of the skull

The plain film, computed tomography (CT) and angiographic findings in 10 patients with primary intraosseous meningioma were reviewed and the differential diagnosis considered. In nine patients with benign primary intraosseous meningioma, the radiological findings revealed intraosseous expansile growth. In one patient with the malignant form of the tumour, osteolytic growth was evident on plain film and CT. In eight patients, the tumour tissue was hyperdense (65-85 HU) on the unenhanced CT images and striking enhancement was shown in seven. In five patients angiography showed that the external carotid artery fed the tumour, while in one the vasculature was normal. Benign primary intraosseous meningioma showed expansile growth and malignant tumour showed osteolytic growth. If a combination of the plain film, angiogram and CT findings is considered, a diagnosis of the benign tumour can be made and a diagnosis of benign meningioma can be suggested.

Primary calvarial meningiomas

Four patients who presented with calvarial masses which subsequently turned out to be meningiomas are presented. Three of these lesions presented with scalp swellings and osteolytic lesions on the plain radiographs. These three lesions had eroded the inner and outer tables of the skull with soft tissue components in the extradural plane. The fourth lesion was an entirely intraosseous meningioma. The clinical, radiological and pathological findings are discussed, and the relevant literature is reviewed.

Primary intraosseous meningiomas.

A retrospective study was performed to evaluate the clinical, radiological and histological findings of 14 intraosseous meningiomas. 14 histologically proved intraosseous meningiomas were studied with plain skull film and CT. Pathological records were reviewed. We found 9 calvarial cases and 5 spheno-orbital ones. The most common symptom in the calvarial cases was a lump in the scalp, and in the spheno-orbital lesions it was exophtalmos. Hyperostosis was present in all 5 spheno-orbital cases and in 3 out of the 9 calvarial ones; in the other 6 cases it had a mixed pattern. Enhanced dura was present in 3 calvarial cases and in 2 sphenoidal ones. Dura was involved in 5 cases: 2 with inflammatory changes, 2 with a minimal intradural tumour and one with a subdural tumour. CT better detected both the bony reaction and the intraosseous extension of the tumour. The dural changes were not specific of tumoural involvement. The differential diagnosis comprises: fibrous dysplasia, osteoma, blastic metastasis and mainly meningioma en plaque (MEP). Comparing our findings with other series, we noticed that in some cases the term MEP was used for similar cases. As the name MEP is merely descriptive and both entities share a larger number of similarities than differences, we believe that a differentiation between hyperostotic en plaque meningioma and intraosseous meningioma can hardly be made.

Intradiploic meningioma of the skull: Case report and review of the literature

Summary An intraosseous calvarial meningioma appeared as a solitary lytic lesion on the plain X ray of the skull. The computerized tomography (CT) of the head showed the lesion confined to the diploe. Only three cases of totally osteolytic intraosseous meningiomas are described in the literature. This is the first case with a CT clearly showing the tumor confined to the bone. It is also the only one with a follow-up magnetic resonance (MR) showing no skull or intracranial tumor.

Primary intraosseous meningioma of the temporal bone in an infant. A case report

Primary intraosseous meningioma of the skull bone is a very rare entity. Although it can occur at any age, it is very rare in children. We present a case and review the literature.

Unusual Lytic Intraosseous Meningioma

Lytic intraosseous meningiomas are rare. This unusual case presented a diagnostic and treatment challenge.

Preoperative difficulties in differentiating intraosseous meningiomas and fibrous dysplasia around the orbital apex

Intraosseous meningiomas and fibrous dysplasia affecting the roof and apex of the bony orbit may be successfully treated using craniofacial techniques. Although both are usually benign conditions, meningiomas require complete excision to prevent recurrence whereas symptomatic and cosmetic correction of fibrous dysplasia may be achieved with partial removal only in the absence of progressive disease. Differentiating the two conditions is therefore important. Errors in diagnosis due to an excessive reliance on diagnostic imaging have occurred on three occasions in this series of 25 patients. This review evaluates the clinical and investigational features that are most helpful in differentiating the two conditions.

Craniofacial Neurosurgical Approach for Extensive Hyperostotic Meningioma

We present a patient with a craniofacial meningioma that had been considered inoperable for 8 years but has now been successfully treated using the combined neurosurgical and craniomaxillofacial approach. The tumor extensively involved the meninges, skull, face, left orbit, and maxilla. Vision and mild proptosis of the left eye had worsened over the last several years. Computed tomography and magnetic resonance imaging scans revealed an extensive intraosseous meningioma with intracranial and extracranial extension. An angiogram revealed an intensely vascularized mass supplied by a markedly enlarged ophthalmic artery. The tumor was approached through a bicoronal incision. The meningioma that extended into the dura was removed entirely from the brain. The left orbital roof and the lateral and medial walls were resected along with the meningioma, which extended through the orbit into the maxilla. The defect in the dura was closed with a pericranial flap. Split parietal bone and lyophilized cartilage were used for reconstruction of the cranial and orbital defects. Three and a half months after the initial surgery, further reconstruction was performed using calvarial, rib, and iliac bone and lyophilized cartilage. A methylmethacrylate implant was inserted but then removed due to chronic wound drainage. It was substituted with demineralized perforated bone implants from Pacific Coast Tissue Bank. Seventeen months after the initial surgery, there was no evidence of the tumor.

Case report 680

Two cases of intraosseous meningioma of the calvaria with hyperostosis are presented and compared with the appearance on plain films and CT of en plaque meningioma, metastatic disease from such primary sites as prostatic cancer, and fibrous dysplasia. It is emphasized that intraosseous meningioma in the calvaria is relatively uncommon, occurring most often in the sphenoid bone (probably because of its numerous articulations). The relationship of the development of intraosseous meningioma to the entrapment of dura containing arachnoid cells is discussed in considering the cause of such lesions, and it is stressed that calvarial fractures and cranial sutures may contribute to the entrapment of arachnoidal tissue and later the formation of a meningioma.

Primary intraosseous meningiomas of the skull base

Four cases of primary intraosseous meningiomas were seen among 373 cases of intracranial meningiomas operated upon in the Neurosurgical Clinic of the Krankenhaus Nordstadt, Hannover, FRG between January 1978 and December 1988. These 4 cases represent 1% of all intracranial meningiomas. Patients' age ranged between 21 and 66 years; 2 were females and 2 males. Presenting symptoms were localized orbital pain in 1 case, protrusion of the eye in 1 patient, pain in the orbit and forehead and protrusion of the eye in 1 patient, and peripheral facial palsy in 1 case. Symptoms lasted between 3 and 10 years. Two tumours were in the bony orbit, 1 in the bony orbit and in the frontal bone and 1 in the temporal bone. All tumours were surgically completely removed. All patients are clinically and computer tomography free of tumour 1 to 8 years after the operation.

Lung Metastasis of Intraosseous Meningioma prior to Craniotomy

A 38-year-old female was admitted, because of a dull headache and a slowly growing, hard, fixed mass in the vertex area. Severe papilledema was noted. Plain roentgenograms of the skull showed thickening of the outer table and diploe at the vertex. Selective external carotid angiography demonstrated enlarging branches of both the superficial temporal artery and middle meningeal artery entering the region of the thickened skull and forming a homogeneous tumor stain. The superior sagittal sinus was obscured beneath the thickened skull. Computerized tomography revealed no intracranial mass lesion. Chest X-ray film showed multiple coin lesions in both the lung fields. During the operation, an intraosseous meningioma was found as well as isolated small intradural tumors. The superior sagittal sinus was grossly collapsed without any tumor masses. These tumors were totally removed (grade 1 removal after Simpson). The postoperative course was uneventful. An open biopsy of one of the lung tumors was performed. The skull, falx and lung tumors were identical in histological appearance and showed typical features of meningotheliomatous meningioma. Without histologically malignant features, meningioma rarely metastasizes. Only 10 cases of metastatic meningioma without craniotomy were reported in the literature from 1941 to 1983. In the present case the lung metastasis seems most likely hematogenous. The route by which the small falx tumors were seeded is not clear.

Primary intraosseous meningioma presenting as a solitary osteolytic skull lesion

Primary intraosseous meningioma presenting as a solitary osteolytic skull lesion