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Meningioma of the falx cerebri with invasion of the superior sagittal sinus

CLINICAL HISTORY:
This 67-year old woman presents with new onset seizures, with clonic contractions of the right lower extremity.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): Displacement of the falx cerebri to the right (arrow) by a slightly hyperdense mass (arrowheads), with broad implantation on the midline.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Homogeneous enhancement of the lesion is appreciated with some edema.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): Mass is slightly hyperintense with surrounding edema. Broad implantation on the falx is noted (arrowheads).

b) CORONAL T1-WEIGHTED (550/20/1) SPIN-ECHO SEQUENCE (IMAGES 4 - 5 - 6): The mass is isointense to grey matter. The falx is bowed to the right. The normal signal void of the superior sagittal sinus has disappeared and is replaced by tumor tissue (long arrow). Definite extension of the tumor into the right hemisphere is identified.

c) CORONAL GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES (IMAGES 7 - 8 - 9): Intense and homogeneous enhancement of the lesion is noted. Note again the obliteration of the superior sagittal sinus (long black arrow) and the extension into the contralateral hemisphere (arrowheads). A dural tail is seen. Some enhancement is noted in the overlying bone (long white arrow).

ANGIOGRAPHY: Lateral view of selective left internal carotid artery injection: venous phase (IMAGE 10): Interruption of the continuity of the superior sagittal sinus over the tumor is confirmed.

RADIOLOGICAL DIAGNOSIS: is falx meningioma based on the broad implantation on the falx and the dura, the intense enhancement and the dural tail. The absence of signal void in the superior sagittal sinus suggests tumor invasion of this sinus. This is confirmed by angiography.

SURGICAL FINDINGS: At surgery, the tumor appeared to have grown through the superior sagittal sinus to the inner table of the overlying bone. Tumor resection was performed with interruption of the superior sagittal sinus and the falx over the insertion of the tumor, up to the site where patent cortical veins entered the superior sagittal sinus.

ANATOMOPATHOLOGY was consistent with arachnotheliomatous meningioma.

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Fig. 1

Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 1
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 2
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 3
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 4
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 5
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 6
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 7
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 8
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 9
Meningioma of the falx cerebri with invasion of the superior sagittal sinus, Fig. 10