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Meningioma of the falx cerebri, case 2

CLINICAL HISTORY:
This 42-year old man suffered his first grand mal seizure 4 months ago. Since then he complains of increasing frontal headache.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): An isodense lesion (arrow) is seen in the right frontal paramedian region, surrounded by a crescent-like hypodense component (arrowheads).

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Intense and homogeneous enhancement of the lesion (arrow) is noted, except for the hypodense area (arrowheads). The lesion is broadly implanted on the convexity and the falx.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): The lesion is irregularly hypointense with a posterior hyperintense component. Note bulging of the falx to the left (arrow) with predominant implantation on the falx.

b) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGE 4): The lesion is more hypodense.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The lesion shows intense but inhomogeneous enhancement. Enhancement is also seen at the periphery of the cystic component (arrowheads). The lesion is broadly implanted on the convexity, but displaces the anterior falx to the left (arrows).

ANGIOGRAPHY: right (IMAGE 8) and left (IMAGE 9) selective internal maxillary artery injection: The tumor is supplied by both middle meningeal arteries.

RADIOLOGICAL DIAGNOSIS is meningioma based on the broad implantation on the falx and the dura of the convexity and the intense enhancement.

SURGICAL FINDINGS: At surgery, the tumor was firmly attached to the falx in the neighborhood of the superior sagittal sinus and only loosely adherent to the convexity. Total resection of the tumor and of the falx at the insertion site of the tumor was performed.

ANATOMOPATHOLOGY (IMAGES 10 AND 11) is consistent with arachnotheliomatous meningioma.

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Meningioma

 

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Fig. 1

Meningioma of the falx cerebri, case 2, Fig. 1
Meningioma of the falx cerebri, case 2, Fig. 2
Meningioma of the falx cerebri, case 2, Fig. 3
Meningioma of the falx cerebri, case 2, Fig. 4
Meningioma of the falx cerebri, case 2, Fig. 5
Meningioma of the falx cerebri, case 2, Fig. 6
Meningioma of the falx cerebri, case 2, Fig. 7
Meningioma of the falx cerebri, case 2, Fig. 8
Meningioma of the falx cerebri, case 2, Fig. 9
Meningioma of the falx cerebri, case 2, Fig. 10
Meningioma of the falx cerebri, case 2, Fig. 11