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Meningioma of the falx cerebri, case 1

CLINICAL HISTORY:
This 51-year old female patient was diagnosed in 1985 with a meningioma of the falx, incidentally discovered on a CT, performed for an acute cerebrovascular incident with left arm paresis. The latter was due to an infarction in the right internal capsule. The paresis totally resolved. Now she complains of increasing headache and weakness of the left arm.

NEUROLOGICAL EXAMINATION shows a decrease in fine motor function of the fingers of the left hand and discrete coordination disturbances.

CT:
a) NON-CONTRAST CT (IMAGE 1) shows a well-defined slightly hyperdense tumor in the right paramedian area, with broad implantation on the falx (arrowheads). A small central calcification (arrow) is seen.

b) CONTRAST-ENHANCED CT (IMAGE 2): Intense and homogeneous contrast enhancement is noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED SPIN-ECHO (6400/120/1) SEQUENCE (IMAGE 3): The tumor (arrowheads) is homogeneously hypointense.

b) TRANSAXIAL T1 WEIGHTED SPIN-ECHO (600/14/1) SEQUENCE (IMAGE 4): The tumor (arrowheads) again is hypointense, as compared to brain.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED T1-WEIGHTED SPIN-ECHO IMAGES show intense and homogeneous enhancement of the tumor (arrowheads).

ANGIOGRAPHY (IMAGE 8): The tumor is supplied by the left middle meningeal artery and is hypervascular.

RADIOLOGICAL DIAGNOSIS is falx meningioma, based on the broad implantation on the falx and the homogeneous enhancement with evidence of a dural tail.

SURGICAL INTERVENTION consisted of total resection via right upper frontoparietal craniotomy.

ANATOMOPATHOLOGICAL EXAMINATION shows meningioma.

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Fig. 1

Meningioma of the falx cerebri, case 1, Fig. 1
Meningioma of the falx cerebri, case 1, Fig. 2
Meningioma of the falx cerebri, case 1, Fig. 3
Meningioma of the falx cerebri, case 1, Fig. 4
Meningioma of the falx cerebri, case 1, Fig. 5
Meningioma of the falx cerebri, case 1, Fig. 6
Meningioma of the falx cerebri, case 1, Fig. 7
Meningioma of the falx cerebri, case 1, Fig. 8