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Meningioma of the falx cerebri, case 3

CLINICAL HISTORY:
This 42-year-old woman suffered a first generalized grand mal epileptic seizure.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): Frontal midline spontaneously hyperdense mass (arrowheads), with some surrounding edema.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Intense and homogeneous enhancement (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (3380/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): In the frontal region a midline mass (arrowheads) is seen centered on the falx. The lesion has low signal intensity.

b) TRANSAXIAL T1-WEIGHTED (5600/15/1) SPIN-ECHO SEQUENCE (IMAGE 4): The mass is hypointense (arrowheads).

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) Gd-ENHANCED SPIN-ECHO SEQUENCES: Homogeneous enhancement (arrows)of the lesion, with evidence of dural enhancement of the falx. The superior sagittal sinus can not be identified.

ANGIOGRAPHY: Lateral view of the left internal carotid artery. Arterial phase (IMAGE 8): Lesion is supplied by the anterior falcine artery (arrowheads) and the middle meningeal artery. Venous phase (IMAGE 9): The superior sagittal sinus is patent (arrow).

RADIOLOGICAL DIAGNOSIS is falx meningioma based on the extraaxial location of the tumor with broad implantation on the falx and the convexity, the homogeneous enhancement and the dural tail. Despite the absence of signal void in the superior sagittal sinus on MRI, this sinus is patent both on angiography and at operation.

SURGICAL INTERVENTION: demonstrated thight adherence to the superior sagittal sinus and the dura, most pronounced in the right paramedian region. Careful dissection of the lesion from the surrounding falx and the cortex was performed. The adherent dura mater was resected.

ANATOMOPATHOLOGY was consistent with psammomatous meningioma.

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Fig. 1

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