Primary Intraosseous Meningioma Research Articles

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.

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.

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.

Cranial Meningiomas Requiring Cranioplasty

Abstract Aims Bone infiltration in association with intracranial meningioma (4.5% of cases) and primary intraosseous meningioma (2%) are rare. Management can be challenging, as cranial vault reconstruction may be required. This study aimed to examine the surgical techniques used and outcomes in this patient population. Method A single-centre, retrospective cohort study was conducted between January 2010 and September 2020. All adult patients who required cranial reconstruction due to bone involvement of their meningioma were included. Patient demographics, tumour characteristics, operative details, complications, and outcomes were examined. Statistical analyses were performed using SPSS v24.0. Results There were 30 patients (17 female; 56.7%), median age 54 yrs (range 28-86 yrs), of whom 25 (83.3%) had bone infiltration, and 5 (16.7%) had primary intraosseous meningioma. Only 10 patients had a Simpson I or II resection. Twenty-eight had 'on-table' primary cranioplasties. Materials used were titanium (n=13; 43.3%), acrylic (n=10; 33.3%), PMMA (n=5; 16.7%), and hydroxyapatite (n=2; 6.7%). There were 9 (mostly minor) surgical complications and only one wound infection. Twelve patients had WHO grade II tumours, and 14 required radiotherapy. Ten patients (33.3%) had re-operation for recurrent tumour, with a median time to progression of 41 months. At 6 months, 24 patients had a performance score less than 2. Conclusion On-table cranioplasty provides a lower risk surgical option for patients with high risk meningiomas.

Primary intraosseous meningioma: a case report

Primary intraosseous meningioma (PIM) is a rare form of meningioma, a benign lesion of the meninges. Imaging evaluation of a patient with frontoparietal scalp swelling revealed an osteoblastic intracalvarial lesion. Following surgical resection, the histological examination revealed an intra-osseous meningioma.
 Birdem Med J 2021; 11(2): 133-136

Benign purely intraosseous meningioma of the skull: Diagnosis and surgical outcomes

Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningiomas that originates within bone. We aimed to characterize the clinical, radiographic, and pathologic features of PIM and the resulting outcomes following resection. Herein we examined a retrospective case series of all patients with a pathologically confirmed WHO grade I PIM that were managed at one of three tertiary care centers. Patients with tumors that demonstrated extraosseous extension or involvement of the dura mater were excluded. The main outcomes included surgical safety and duration of local tumor control. Nine patients were identified with benign PIMs, presenting with headaches or painless enlarging subcutaneous masses if involving the calvarium or with neurologic deficits if involving the skull base, or otherwise incidentally identified. Surgery was pursued for symptomatic relief and/or tissue diagnosis. Lesions were evaluated by radiographic imaging – including sensitive detection by plain X-ray films – and definitive diagnosis ascertained by histopathological examination. Maximal resection of both calvarial and skull base lesions was safely tolerated. PIM represents a rare benign skull lesion, whose identification depends on the integration of radiographic findings with intraoperative findings and histopathological confirmation; it should be considered in the differential for slow-growing expansile intraosseous lesions of the skull.

Incidental Diagnosis of an Arachnoid Granulation on Ga-68 DOTATATE PET/MRI.

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Meningeoma intraoseo primario. Reporte de caso y revisión de literatura

Los Meningiomas que se desarrollan en localizaciones ectópicas representan solo del 1 al 2% del total de los Meningiomas.El término Meningioma Extradural Primario (MEP) refleja que el origen de estos tumores es aislado de la cobertura dural decualquier parte del cerebro y la medula espinal. Meningioma Intraóseo Primario (MIoP) describe un subtipo de MEP que surge en el hueso y representa aproximadamente dos terceras partes de la totalidad de todos los Meningiomas Extradurales. La presentación clínica de las lesiones y los diagnósticos diferenciales dependen primariamente de la localización de la lesión, tamaño y estructuras vecinas. La apariencia radiologica de los Meningiomas intraóseos depende en gran medida de su localización y los efectos que producen al invadir el hueso. Los tumores son típicamente osteoblasticos u osteoliticos. Los Meningiomas intraóseos son indistinguibles Histologicamente e Inmunofenotipicamente de su contraparte los Meningiomas Intracraneales. Cuando la escisión quirúrgica es el tratamiento de elección la potencial curación del paciente es posible.

Primary intraosseous meningioma: clinical, histological, and differential diagnostic aspects.

Primary intraosseous meningioma (PIM) is a rare manifestation of meningioma, a benign, neoplastic lesion of the meninges. Its characteristic appearance is hyperostosis, while no or only minimal dural changes can be observed. This study aims to characterize this rare entity from both a clinical and histopathological point of view in order to improve clinical management. In the years 2009-2017, 26 cases of PIM were diagnosed using MRI and CT scans. In 16 cases the indication for resection was given, and specimens were further examined using a multilevel approach, including histological and immunohistochemical analyses. Additionally, the local database was searched for all cases of meningiomas, as well as osteosclerotic differential diagnoses-i.e., fibrous dysplasia, Paget's disease of bone, and other benign osteosclerotic lesions. In this study, PIM represented 2.4% of all meningiomas with a predominant occurrence in females (85%). Regarding the initial manifestation, PIMs show a slightly earlier onset than meningiomas. While most PIMs are located in the sphenoid bone, associated calcifications were visible in 58% of the cases on CT scans. Most of the cases were classified as WHO grade I (93%) and meningotheliomatous meningiomas (91%). Tumor growth was associated with an increased bone resorption followed by massive osteoid deposition and consecutive sclerosis. The frequently observed frayed appearance results from multiple bony canals, which contain blood vessels for the blood supply of the highly vascularized tumor tissue. PIM is a rare but important differential diagnosis for osteosclerotic lesions of the skull, especially in women. Tumor-induced, cellular-mediated bone resorption and formation may play a central role in the underlying pathogenesis.

Malignant primary intraosseous meningioma in a pediatric patient: A case report and review

Abstract Introduction This is the first case of a malignant, pediatric PIOM reported in the United States. Primary extradural meningiomas (PEM) arise in locations other than dura, outside the intracranial compartment. Primary Intraosseous Meningiomas (PIOMs) are a rare subset of PEM that arise in bone. Case report A 16 year old female, neurologically intact, mildly tender swelling over her right forehead that increased in size, accompanied by headaches and dizziness. Imaging demonstrated a lesion infiltrating the frontal calvarium and the adjacent intracranial and extracranial soft tissues. Surgical resection was performed. Pathology supported the diagnosis of anaplastic meningioma (WHO grade III). Discussion PIOMs are a rare subset arising in bone. In an extensive review, less than 150 cases of PIOMs were found. It likely originates from entrapment of arachnoid cap cells, congenitally or after development. Treatment is similar to intradural meningiomas, namely a potentially curative resection. Resection and cranioplasty should be performed simultaneously. Adjuvant radiation, chemotherapy and bisphosphonates are recommended.

Primary intraosseous meningioma: atypical presentation of a common tumor.

Primary intraosseous meningioma: atypical presentation of a common tumor.

Frontal intradiploic meningioma with progressive intracranial invasion: A rare case report.

Rationale:Intradiploic meningiomas are a subset of extradural meningiomas that arise in the skull. They are mostly localized in the frontoparietal and orbital regions, and they are often mistaken for primary bone tumors.Patient concerns:The patient was a 48-year-old man with headache and a 12-year history of frontal cranium occupation, which was first discovered in 2005 and enlarged in 2009. The patient had a history of fracture in his frontal cranium 12 years ago. The computed tomography and magnetic resonance imaging revealed an occupation and intracranial invasion in frontal cranium. And the angiography showed an occlusion at the anterior part of sagittal sinus.Interventions:Bilateral frontal craniotomy, intracranial tumor resection, and cranioplasty were performed.Diagnosis:Histologic examination confirmed an intradiploic ectopic meningioma (World Health Organization Grade I).Outcomes:He was discharged with no neurological deficits 3 days after surgery. At the 6-month clinical follow-up, there was no tumor recurrence or other complaints.Lessons:In this study, we present the case of a frontal intradiploic meningioma with progressive intracranial invasion and review the radiographic and clinical findings of patients with primary intraosseous meningioma.

Unusual primary intraosseous meningioma, mimicking cranial osteoid osteoma: A radiological clue to the differential diagnosis

Unusual primary intraosseous meningioma, mimicking cranial osteoid osteoma: A radiological clue to the differential diagnosis

Primary intraosseous meningioma: an osteosclerotic bone tumour mimicking malignancy

BackgroundSclerotic tumours of the calvarial bones are rare and may be due to primary and secondary bone tumours as well as extradural tumours of meningeal origin.Case presentationWe report a case of primary intraosseous meningioma (PIM) which arose in the frontal bone of a 63 year old woman who complained of progressive pain and thickening of the right skull. Radiology showed a large osteosclerotic lesion in the right frontal bone. Histology showed an intraosseous lesion containing dense fibrous tissue in which there were scattered cells that expressed epithelial membrane antigen and progesterone receptor. The tumour was partially resected and 3 years after operation has not recurred.ConclusionsPIM is a rare tumour which needs to be distinguished from primary/secondary osteosclerotic calvarial bone tumours.

Primary intraosseous atypical inflammatory meningioma presenting as a lytic skull lesion: Case report with review of literature

Primary extradural meningiomas of the skull comprise 1% of all meningiomas, and lytic skull meningiomas are still rarer and are said to be more aggressive. We present a case of 38-year-old male with an extradural tumor which on histopathological examination showed features of inflammatory atypical meningioma (WHO Grade II). The intense inflammatory nature of osteolytic primary intraosseous meningioma has not been reported before. This entity deserves special mention because of the need for adjuvant therapy and proper follow-up.

Primary intraosseous meningioma.

Meningioma originates from arachnoid cap cells and is usually dura-based and slow growing. They account for 15% to 20% of primary brain tumors. Primary intraosseous meningioma (PIM) is a type of ectopic meningioma, and has been rarely reported. PIMs have been reported to constitute less than 2% of meningiomas, and are usual reported in the frontotemporal regions of the calvarium [1], orbits, and anterior cranial fossa. Frequently, patients with PIM of the orbit complain of aesthetic problems. We report a case of PIM of the orbit. A 54-year-old female had presented with gradually progressive exophthalmos of 5 months duration (Fig. 1). The patient had no pain or visual symptom, and there was no previous ocular trauma history. Ophthalmologic and neurologic examinations were normal finding except for 5 mm of exophthalmos. Facial computed tomography (CT) scan revealed thickening of cortical bone of the orbital wall at the right sphenoid wing (Fig. 2). The radiologic diagnosis of preoperative facial CT was fibrous dysplasia of the right lateral orbital wall and right skull base. Fig. 1 Preoperative view. Fig. 2 Preoperative facial computed tomography. Lateral eyebrow and subciliary incision were followed by parallel upper and lower ostectomies at the lateral orbital rim. The osteomised bone segment was excised to create enough space to approach the main mass at the right sphenoidal bone and part of the orbit lateral wall. The bony mass was removed with a high-speed drill and oscillating saw. The osteomised orbital rim segment was repositioned using fixation devices. The main mass consisted of fragile abnormal bone, resembling that of fibrous dysplasia. Histopathologic examination confirmed the diagnosis of meningioma. In microscopic views, oval and spindle shaped cells formed lobules between woven bones. Nuclei frequently exhibited central clearing and whorls were viewed. Cytoplasm and surrounding collagen were immunohistochemically positive for epithelial membrane antigen, and negative for glial fibrillary acidic protein (GFAP), cytokeratin (AE1/AE3), and Ki-67 (Fig. 3). At 3 months after surgery, exophthalmos was reduced to 2 mm, that is, into the relatively normal range (Fig. 4). On postoperative CT, most of the bone mass was removed but minimal amount of mass remained (Fig. 5). Although secondary surgery for complete resection of the mass was planned at 12 months after surgery, the patient was satisfied with the aesthetic results and was not willing to undergo additional surgery. Fig. 3 Epithelial membrane antigen positive finding (magnification, ×100, epithelial membrane antigen immunostain). Fig. 4 Postoperative view. Fig. 5 Postoperative facial computed tomography. Extradural meningiomas are uncommon, and more than 90% of extradural meningiomas occur in the head and neck [2]. Nevertheless, many other locations have been reported, such as, scalp, calvaria, orbit, paranasal sinus, neck, lung, mediastinum, skin, and finger. The differentiation of PIM and intradural meningioma depends on the presence of dural invasion. Hoye et al. [3] defined PIM as not involving the dura, but Lang et al. [2] did not treat dural invasion as an exclusive criteria and regarded main mass location, growth direction, and dural displacement pattern to be of greater importance. The majority of PIMs of the skull base and orbital walls present with pain, exophthalmos, and deformity. PIMs are generally benign and slow growing, but a higher proportion are associated with malignant change than standard meningioma [2]. These tumors are characterized by an intraosseous mass growth leading to significant hyperostosis involving the sphenoid wing, orbital roof, lateral orbital wall, and the middle fossa cranial base and a thin, usually soft-tissue growth at the dura. Several hypotheses have been proposed for the origin of PIM. Azar-Kia et al. [4] suggested that PIM arises from arachnoid cap cells trapped in the cranial suture during birth. In the reports issued by Lang et al. [2] and Crawford et al. [5] 8% and 64%, respectively, were suture related masses. It has also been proposed that PIM arises from dura and arachnoid entrapment caused by previous trauma. The third hypothesis is extradural meningioma arise from multipotent mesenchymal cells, which could explain masses located far from the head and neck. PIM is the condition most commonly confused with fibrous dysplasia. Both PIM and fibrous dysplasia expand bone and have a ground glass appearance. However, in intraosseous meningioma, there is irregularity of the cortical bone. In fibrous dysplasia, on the other hand, the bone is enlarged but follows the normal position and intact cortical bone. Surgical resection is required for symptomatic PIM. Excision of the tumor with reconstruction of bone as required is the choice of operation. Operations must be designed to achieve symmetry of both eyes, as proper facial symmetry and tumor resection are important for achieving successful aesthetic outcomes. In conclusion, we reported a rare case of PIM of the orbit that present with progressive exophthalmos. Surgical resection was performed to lessen avoidable morbidity. The patient was satisfied with the aesthetic results achieved.

Primary Intraosseous Meningioma in the Orbital Bony Wall: A Case Report and Review of the Literature Review

Primary Intraosseous Meningioma in the Orbital Bony Wall: A Case Report and Review of the Literature Review

Primary Intraosseous Osteolytic Meningioma of the Skull Mimicking Scalp Mass: A Case Report and Review of Literature.

Primary extradural meningioma is about 1-2% of all meningiomas. Primary intraosseous meningioma is a rare form of intra-bone tumors that account for approximately 67% of extradural meningiomas. We report a primary intraosseous meningioma of a 69-year-old man who had headaches and a mass on right parietal scalp for the past few months. Remarkably, the brain tissue within the osteolytic cavity of the skull was normal in computed tomography and magnetic resonance images. Resection, duraplasty, and cranioplasty were performed. The patient's symptoms disappeared after surgery, and the histological diagnosis was an osseous meningothelial meningioma (World Health Organization grade I).