Bone Meningiomas Research Articles

Primary Temporal Bone Meningioma Extending into the Middle and External Ear – A Rare Case Report with Review of Literature

Primary temporal bone meningioma of the middle ear is relatively rare in clinical practice. It is difficult to distinguish it from otitis media with effusion or chronic otitis media owing to its similar clinical presentation. We report the case of a 73-year-old temporal bone meningioma extending to the middle ear as well as involving the external auditory canal. High-resolution computed tomography revealed the possibility of left chronic otomastoiditis. After debulking and biopsy, it turned out to be an extracranial meningioma.

Investigation of tissue perfusion of the brain in patients with large and giant tumors of the bridge-cerebellar angle

The article presents the results of the study of pons and cerebellar tissue perfusion in patients with large and giant cerebellopontine angle tumors. Perfusion computed tomography was performed in 10 patients with vestibular schwannomas and 8 patients with temporal bone meningiomas. The parameters of cerebral blood flow were calculated in 6 regions of interest in the area of the pons and the cerebellar hemispheres. There are manifestations of brain tissue hypoperfusion in the pons and hyperemia in the nearby parts of the cerebellar hemisphere. The revealed changes indicate the possibility of disorders of local cerebral blood flow after surgery.

Circular multiple burr hole for surgical removal of an extra and intracranial meningioma (technical note)

Introduction. Intracranial meningiomas are the most common primary central nervous system tumors and are mostly benign, arising from the meninges surrounding the brain, nerves, and vessels. An obstacle to the surgical resection of meningiomas is the risk of injury to the superior sagittal sinus and the resulting compromise to the integrity of the venous drainage. This article describes a circular multiple trepanation technique, which can be used to safely perform resection of extracranial and intracranial meningiomas, aiming to reach the largest possible tumor area, since patient prognosis is directly proportional to tumor resection.Surgical technique. The first step is to make a horseshoe incision, then drill burr holes, forming a circumference around the bone meningioma. The next step is to connect the orifices, incising the dura mater affected by the tumor along the periphery of the extracranial meningioma. Subsequently, the bone and the dura mater are elevated. Thus, the bone and dural part are separated from the intradural part, which is, in turn, removed later. Results. The circular multiple trepanation technique was performed and a gross total resection of the extracranial and intracranial meningioma (Simpson grade I) was achieved. The postoperative period showed positive results, with an improvement in the patient’s eye disorder and interruption of generalized tonic‑clonic seizures.Conclusion. The circular multiple trepanation approach for treating extracranial and intracranial meningiomas described in this note is performed safely and effectively, with good patient prognosis. Although it is a recognized option, it has been insufficiently described, and it is therefore important to expand the knowledge and proper use of this technique among neurosurgeons.

Primary Temporal Bone Meningioma Presenting as Chronic Mastoiditis and Sigmoid Sinus Thrombosis: Report of a Case with Literature Analysis

Primary extra cranial meningioma of the ear and temporal bone are exceedingly rare, making up less than 1% of all meningiomas. Histologically, they are indistinguishable from their intracranial counterpart.

Meningeom spánkové kosti

The aim of this case report is to discuss a very rare pathology – temporal bone meningioma. The extracranial location of meningiomas and temporal bone meningioma is a very rare condition. The symptomatology of temporal bone meningiomas is nonspecific, imitating chronic otitis media with cholesteatoma. However, temporal bone meningioma has a distinctive image on computed tomography. There is a change in the architecture without bone destruction that should be known by otorhinolaryngologist and radiologist. Magnetic resonance paging should be performed when temporal bone meningioma is suspected. The management of temporal bone meningiomas depends on a variety of factors. The most common therapy includes a combination of neurosurgical and otological surgery. There are also alternatives like stereotactic irradiation.

Temporal bone meningiomas: emphasizing radiologic signs to improve preoperative diagnosis.

Temporal bone meningioma is an extremely rare disease. Lack of clinical attention due to its rarity might lead to delayed diagnosis. This short communication aims to emphasize radiologic signs of temporal bone meningiomas to improve preoperative diagnosis. Radiological characteristics of temporal bone meningiomas are discussed. Temporal bone meningioma is characterized by diffuse "hairy" trabecular hyperostosis without the destruction of trabecular structures, bone thickening, and irregular surface margins of the temporal bone on computed tomography. The dural tail sign is a unique feature of temporal bone meningioma on magnetic resonance imaging. Otolaryngologists certainly should be aware of characteristic radiologic signs of temporal bone meningiomas. Using modern computed tomography and magnetic resonance imaging protocols enables with a high degree of accuracy to distinguish temporal bone meningiomas from other more common entities in this location.

Clinicoradiologic Characteristics of Temporal Bone Meningioma: Multicenter Retrospective Analysis.

Meningioma is a neoplasm arising from cells related to the arachnoid villi. The aim of the present study was to explore the clinical and radiological characteristics of temporal bone meningioma (TBM) in a multicenter cohort. Retrospective cohort study. Thirteen patients diagnosed with TBM at eight medical institutes between 1998 and 2018 were retrospectively enrolled. The clinical procedures, symptoms, signs, and images that led to the diagnosis of TBM were investigated for all patients. The most common symptom at the initial visit was hearing loss (n = 12/13, 92.3%). All patients exhibited unilateral TBMs with varied symptom durations (1-60 months). Four patients presented masses occupying the external auditory canal; the tympanic membrane (TM) could not be evaluated. The other nine patients did not show TM perforation despite the presence of inflammatory signs. The majority of patients exhibited unilateral conductive or mixed hearing loss. A retrospective review of temporal bone computed tomography (TBCT) images revealed findings suggestive of a tumor in all patients. However, three patients had been misdiagnosed with chronic otitis media and were subjected to tympanomastoidectomy (n = 3/7, 42.9%). TBCT findings that suggested TBM included diffuse trabecular hyperostosis in the middle and posterior cranial fossae and widening and destruction of the temporal bone in the jugular bulb area. TBM should be suspected if patients exhibit persistent inflammatory symptoms or signs involving intact TM or unilateral conductive or mixed hearing loss with trabecular hyperostosis or destruction of the temporal bone on computed tomography images. 4 Laryngoscope, 131:173-178, 2021.

Piezosurgery-A Safe Technique to Perform Lateral Suboccipital Craniotomy?

Piezosurgery (PS) is a relatively new technique based on microvibrations generated by the piezoelectric effect. It selectively cuts bone tissue and preserves the surrounding soft tissue. To evaluate the use of PS for performing lateral suboccipital craniotomy. PS was used to perform a lateral suboccipital craniotomy in 22 patients who underwent surgery for different cerebellopontine angle (CPA) pathologies in the neurosurgical department. The applicability of PS for lateral suboccipital craniotomy was evaluated with respect to safety, preciseness of bone cutting, and in particular the preservation of the adjacent dura and sigmoid and transverse sinuses. Lateral suboccipital craniotomy in 22 patients who underwent surgery for different CPA pathologies (13 vestibular schwannoma, 5 petrous bone meningioma, 1 petroclival meningioma, 2 epidermoid cysts, and 1 petrous bone cholesterol granuloma) was performed with PS without any complications. A burr hole was set before piezosurgical craniotomy in 6 patients, with no prior burr hole in 16 patients. Incidental durotomy during piezosurgical craniotomy occurred in 6 patients, and small lacerations of the sigmoid sinus caused by the piezosurgical device were observed in 3 patients. Although PS is a safe and selective bone cutting technique that preserves the surrounding soft tissue, it can still lead to unintended dural tears during lateral suboccipital craniotomy. This must be kept in mind when using PS for craniotomies and relying on the selective bone cutting properties of PS.

Temporal bone meningioma involving the middle ear: A case report.

Meningioma is a common intracranial tumor involving the meninges. The localization of this type of tumor is rarely extracranial due to its typically low invasive properties. Furthermore, invasion of the middle ear is exceptional. The present study reported a case of meningioma extending into the middle ear from the middle cranial fossa through the tegmen tympani. The clinical and pathological characteristics, as well as the outcome of the patient, were described.

A rare infectious presentation of a temporal bone meningioma

To the Editor, En plaque meningiomas of the temporal bone commonly have years of delay in diagnosis due to the chronic nature of the presenting symptoms, which include serous otitis media and aural fullness, and the lack of compressive symptoms seen with bulky mass tumors [1]. We present a rare case of an en plaque temporal bone meningioma with an acute and critical presentation secondary to infectious processes that were a direct result of local invasion. Bacterial meningitis, brain abscess, and mastoiditis with secondary septic thrombosis were the salient presenting features in this case. This presentation is very atypical of temporal bone meningiomas, but failure to recognize these associations can result in missed diagnosis in critically-ill patients.

WITHDRAWN: A rare case of primary intraosseous calvarial osteoblastic meningioma of the frontal bone in a young child

Meningioma is a common intracranial neoplasm, accounting for 15–20% of all brain tumours. The “Primary Extradural Meningioma (PEM)” is an uncommon manifestation and a rare separate subset which arises outside the intracranial compartment, accounting for just 1–2% of all meningiomas. Primary calvarial intraosseous meningiomas comprise two thirds of these extradural meningiomas. They are usually seen in the 4th or 5th decades of life and have a predilection for females. We present a rare case of a very large Primary osteoblastic intradiploic calvarial meningioma in a young 11 year old male child, with a clinical and radiographic appearance simulating an Osteoma or Fibrous dysplasia. The findings on Radiographs, Computed Tomographic (CT) scans, Magnetic Resonance Imaging (MRI), the histological features and surgical treatment of this rare lesion are described.

A Rare Case of Intra-Osseous Meningioma of the Sphenoid Bone - A Case Report

A 42-year-old female patient presented with loss of vision and proptosis of her right eye. Computerized tomography (CT) scan revealed hyperostotic lesion involving the right sphenoid ridge, anterior clinoid process and roof and lateral wall of orbit with mass effect on the intraorbital contents. CT findings were suggestive of intra-osseous meningioma arising from right sphenoid bone. Later, MRI of the brain and orbit and histopathology of the lesion confirmed the case as an intra-osseous meningioma of the sphenoid bone. Though meningioma of tuberculum sella and primary calvarial meningioma were reported earlier, intraosseous meningioma of the sphenoid bone is rare. DOI: http://dx.doi.org/10.3329/imcj.v6i2.14737 Ibrahim Med. Coll. J. 2012; 6(2): 73-75

Petrous Bone Meningiomas: Surgical Results in 110 Cases

Petrous Bone Meningiomas: Surgical Results in 110 Cases

Posterior petrous bone meningiomas: surgical experience in 53 patients and literature review

Meningiomas of the posterior fossa represent a heterogeneous group of tumors regarding difficulty of resection and functional outcome. The aim of this review was to focus on tumors located mainly on the posterior surface of the petrous bone and threatening hearing and facial functions. An anatomical classification was used to evaluate surgical outcome depending on the relationship of the tumor to the internal auditory meatus. The authors performed a retrospective chart review of 53 consecutive patients operated on for a posterior petrous bone meningioma in a tertiary referral center and a literature review. Tumors were classified in four groups according to the modified Desgeorges and Sterkers classification: posterior petrous (P; 17 tumors), meatus and internal auditory canal (M; 12 tumors), petrous apex without invasion of the internal auditory canal (A; 9 tumors), and cerebellopontine angle with invasion of the internal auditory canal (AMP; 15 tumors). The facial function was preserved in 100% of P and A tumors, 75% of group M tumors, and 53% of AMP tumors. Hearing preservation was attempted only in P, A, and M groups where rates of serviceable hearing preservation were 82%, 80%, and 66%, respectively. The cumulative rate of hearing preservation for AMP tumors was 45% in our literature review. The increased facial morbidity associated with AMP tumors compared with other groups was also confirmed by the review of the literature. In conclusion, this study shows that among posterior petrous bone meningiomas, tumors invading the internal auditory canal present with increased postoperative functional morbidity in spite of a tailored approach regarding dural insertion.

Decision making for the surgical approach of posterior petrous bone meningiomas

The authors undertook this study to examine the surgical approaches used to treat posterior petrous bone meningiomas at a single institution and retrospectively evaluate their surgical strategy based on a previously published classification. Cases in which craniotomies were performed to treat posterior petrous bone meningiomas between 2002 and 2010 were retrospectively reviewed. Data were examined from 57 patients who were treated for 59 tumors. The tumors were classified into 3 types according to the location of their primary dural attachment: Type A, located around the porus trigeminus (33 tumors); Type M, located at the level of the porus of the internal auditory canal (IAC) (12 tumors); and Type P, located laterally to the IAC (14 tumors). The median tumor diameter was 34 mm (range 20-67 mm). The choice of the approach was based on tumor location, as the displacement of vascular structures and cranial nerves was primarily determined by the site of dural attachment on the posterior petrous bone. An anterior petrosectomy was performed in 82% of Type A meningiomas, and a retrosigmoid approach was used in 86% of Type P meningiomas. The spectrum of approaches was less uniform for Type M meningiomas. Overall, total resection was obtained in 39% of all cases, and in 18%, 50%, and 86% of Type A, Type M, and Type P tumors, respectively. The postoperative mortality rate was 8.8% (5 deaths among 57 patients), and all 5 patients who died during the early postoperative period had large Type A tumors. At last follow-up, the functional preservation of the facial nerve was excellent in 49 (94%) of the 52 surviving patients. The authors believe that proper selection of the approach favorably impacts functional outcome in patients undergoing surgery for the treatment of skull base tumors. In the authors' case series of posterior petrous bone meningiomas, Type P and most Type M tumors were safely managed through a regular retrosigmoid approach, whereas Type A tumors were optimally treated via an epidural anterior petrosectomy.

Combined Petrosal Approaches in the Management of Temporal Bone Meningiomas

To evaluate the indications and outcomes of the combined petrosal approaches in the surgical management of temporal bone meningiomas. Retrospective chart review. University teaching hospital. Adults with temporal bone meningiomas. Meningioma removal using a combined petrosal approach. Cranial nerve outcomes, complications, completeness of resection, and recurrence rates. Forty-nine patients underwent surgical excision of a temporal bone meningioma between 1996 and 2004 at our institution. Nineteen of these patients required a combined petrosal approach for excision. The most common presenting complaints were balance disturbance, 11 (58%); hearing loss, 10 (53%); headache, 10 (53%); and tinnitus, 9 (47%). The most common tumor origin was of the petrous ridge (14; 74%). Average tumor size was 3.1 cm. Complete resection was possible in 17 (89%) patients. Upper cranial nerve (III-VI) function was improved in two (11%) patients and worsened in three (16%) patients. Lower cranial nerve (IX-XII) function improved in one (5%) patient and was worsened in one (5%) patient. Postoperative facial nerve function was Grades I to II in 16 (84%) patients and Grades III to IV in 1 (5%) patient at last follow-up. Hearing data were available in 14 patients. Of those patients, 11 (85%) had serviceable hearing after surgery. The most common surgical complication was a cerebrospinal fluid leak, with three (16%) incidences. There were no reported incidents of stroke, death, or meningitis in the cohort. The use of the combined petrosal approach for temporal bone meningioma resection results in favorable outcomes for the patient. The incidence of complications is acceptably low, and cure rates are high.

Petrous Bone Meningiomas

Petrous bone meningiomas do not represent, from the surgical point of view, a homogeneous group of tumors. We have identified four groups of tumors according to the different areas of origin on the posterior surface of the petrous bone. The aim of this study is to evaluate the prognosis in relation to tumor location and cranial nerve involvement. In the last 15 years we have operated on 55 patients having petrous bone meningioma: 44 females, 11 males, from 16 to 75 years of age. In 16 patients the origin of the tumor was posterior to the internal auditory canal (IAC) (Group A). In 24 cases the origin was adjacent to the IAC (Group B): between the IAC and the jugular foramen (B1) or between the IAC and the tentorium (B2). In 10 cases the tumor was of small size anterior to the IAC, corresponding to the petros apex (Group C); in 5 cases the origin was broad-based on the posterior surface of the petrous bone (Group D). All patients were operated on using a retrosigmoid approach.

Temporal bone secretory meningioma presenting as a middle ear mass

A 44-year-old woman presented with a history of increasing left hypoacusis and sporadic vertigo. CT scan revealed a tumor occupying the mastoid, middle ear, and external auditory canal. After surgical removal, a typical secretory meningioma was diagnosed. The histological hallmark and the immunohistochemical profile of secretory meningiomas are reviewed. The differential diagnosis of this tumor in this location is also commented on. As far as we know, primary temporal bone meningiomas with secretory histology have not been previously reported in the medical literature.

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 Ear and Temporal Bone Meningiomas: A Clinicopathologic Study of 36 Cases with a Review of the Literature

“Primary” ear and temporal bone meningiomas are tumors that are frequently misdiagnosed and unrecognized, resulting in inappropriate clinical management. To date, a large clinicopathologic study of meningiomas in this anatomic site has not been reported. Thirty-six cases of ear and temporal bone meningiomas diagnosed between 1970 and 1996 were retrieved from our files. Histologic features were reviewed, immunohistochemical analysis was performed (n = 19), and patient follow-up was obtained (n = 35). The patients included 24 females and 12 males, aged 10–80 years (mean, 49.6 years), with female patients presenting at an older age (mean, 52.0 years) than male patients (mean, 44.8 years). Patients presented clinically with hearing changes (n = 20), otitis (n = 7), pain (n = 5), and/or dizziness/vertigo (n = 3). Symptoms were present for an average of 24.6 months. The tumors affected the middle ear (n = 25), external auditory canal (n = 4), or a combination of temporal bone and middle ear (n = 7). The tumors ranged in size from 0.5 to 4.5 cm in greatest dimension (mean, 1.2 cm). Radiographic studies demonstrated a central nervous system connection in 2 patients. Histologically, the tumors demonstrated features similar to those of intracranial meningiomas, including meningothelial (n = 33), psammomatous (n = 2), and atypical (n = 1). An associated cholesteatoma was identified in 9 cases. Immunohistochemical studies confirmed the diagnosis of meningioma with positive reactions for epithelial membrane antigen (79%) and vimentin (100%). The differential diagnosis includes paraganglioma, schwannoma, carcinoma, melanoma, and middle ear adenoma. Surgical excision was used in all patients. Ten patients developed a recurrence from 5 months to 2 years later. Five patients died with recurrent disease (mean, 3.5 years), and the remaining 30 patients were alive (n = 25, mean: 19.0 years) or had died (n = 5, mean: 9.5 years) of unrelated causes without evidence of disease. We conclude that extracranial ear and temporal bone meningiomas are rare tumors histologically similar to their intracranial counterparts. They behave as slow-growing neoplasms with a good overall prognosis (raw 5-y survival, 83%). Extent of surgical excision is probably the most important factor in determining outlook because recurrences develop in 28% of cases.