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Hemangioblastoma, case 1 Hemangioblastoma, case 2 Hemangioblastoma, case 3 Hemangioblastoma, intraventricular Hemangiopericytoma Hemangiopericytoma, anaplastic Hemangiopericytoma, evolution Meningioma, atypical: case 1 Meningioma, atypical: case 2 Meningioma, convexity, T2 hyperintense Meningioma, cystic Meningioma en plaque Meningioma, intraventricular, possibly anaplastic Meningioma, lipoblastic Meningioma, multiple Meningioma of the cavernous sinus Meningioma of the cavernous sinus, totally calcified Meningioma of the cerebellopontine angle Meningioma of the falx cerebri, case 1 Meningioma of the falx cerebri, case 2 Meningioma of the falx cerebri, case 3 Meningioma of the falx cerebri with invasion of the superior sagittal sinus Meningioma of the foramen magnum Meningioma of the olfactory groove, case 1 Meningioma of the olfactory groove, case 2 Meningioma of the posterior fossa with intracanalicular enhancement Meningioma of the sellar diaphragm Meningioma of the sphenoid Meningioma of the tentorium, case 1 Meningioma of the tentorium, case 2 Meningioma of the tentorium with extension through the incisura tentorii Meningioma of the tentorium with supra- and infratentorial extension Meningioma of the tuberculum sellae Meningioma, pseudocystic Meningioma, totally calcified Meningioma wiht bone invasion Meningioma with hyperostosis of the bone Pseudomeningioma, metastasis Solitary fibrous tumor, case 1 Solitary fibrous tumor, case 2 Typical meningioma, convexity

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Meningioma of the olfactory groove, case 2

CLINICAL HISTORY:
Three months ago, this 66-year old female patient suffered depression with agitation, accompanied by vomiting and depressed level of consciousness. Now she is admitted with a frontal syndrome, myoclonia of the left side of the face with blepharospasm.

NEUROLOGICAL EXAMINATION reveals instability of gait, discrete left facial nerve paresis, anosmia and diminished sensation of touch in the V-2 territory.

CT:
a) NON-CONTRAST CT (IMAGE 1) shows a huge inferior frontal mass with extensive calcification and some edema.

b) CONTRAST-ENHANCED CT (IMAGE 2): Intense and homogeneous enhancement of the tumor is seen.

MRI:
a) TRANSAXIAL T2-WEIGHTED SPIN-ECHO (3380/90/1) SEQUENCE (IMAGES 3 AND 4) shows a huge inferior frontal mass in contact with the base of the skull. The lesion is well delineated and is surrounded by some edema. The tumor is almost isointense to grey matter, with some intratumoral hyperintense strands. The calcifications are not clearly visible.

b) TRANSAXIAL T1 WEIGHTED SPIN-ECHO (560/15/1) SEQUENCE (IMAGES 5 AND 6): The tumor is isointense to grey matter.

c) TRANSAXIAL (IMAGES 7 AND 8), SAGITTAL (IMAGES 9 - 10 AND 11) AND CORONAL (IMAGE 12) GADOLINIUM-ENHANCED T1-WEIGHTED SPIN-ECHO SEQUENCES show slightly inhomogeneous enhancement of the tumor. The lesion has a broad implantation on the base of the anterior cranial fossa and extends up to the chiasmatic sulcus. Part of the tumor seems to have grown through the lamina cribrosa (arrows image 10).

ANGIOGRAPHY (IMAGES 13 AND 14): Selective right internal carotid artery injection (IMAGE 13) shows substantial posterior displacement of the anterior cerebral artery (arrowheads), which is elevated from the floor of the anterior cranial fossa. Some tumor vascularity is seen, mainly from ethmoidal branches of the ophthalmic artery and by the frontopolar artery. Selective injection of the right internal maxillary artery (IMAGE 14) shows hypertrophy of the middle meningeal artery supplying a typical tumor blush with a stellate configuration of the arteries.

RADIOLOGICAL DIAGNOSIS is meningioma of the olfactory fossa based on the extraaxial location, the calcifications, the broad implantation on the dura of the anterior cranial fossa and the intense enhancement.

SURGICAL INTERVENTION was performed via bifrontal craniotomy. Anteriorly the tumor was covered by a very thin layer of normal cortex. After incision of the tumor capsule, the tumor was progressively excavated. The lesion was moderately vascular. Resection was facilitated by coagulation of the supplying ethmoidal branches and frontopolar arteries. The insertion of the tumor was identified from the planum sphenoidale up to the chiasmatic sulcus. The lamina cribrosa was depressed but not invaded. The olfactory nerve could no longer be identified.

ANATOMOPATHOLOGICAL EXAMINATION was consistent with transitional meningioma with numerous psammoma bodies.

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Fig. 1


Meningioma of the olfactory groove, case 2, Fig. 1	Meningioma of the olfactory groove, case 2, Fig. 2	Meningioma of the olfactory groove, case 2, Fig. 3

Meningioma of the olfactory groove, case 2, Fig. 4	Meningioma of the olfactory groove, case 2, Fig. 5	Meningioma of the olfactory groove, case 2, Fig. 6

Meningioma of the olfactory groove, case 2, Fig. 7	Meningioma of the olfactory groove, case 2, Fig. 8	Meningioma of the olfactory groove, case 2, Fig. 9

Meningioma of the olfactory groove, case 2, Fig. 10	Meningioma of the olfactory groove, case 2, Fig. 11	Meningioma of the olfactory groove, case 2, Fig. 12

Meningioma of the olfactory groove, case 2, Fig. 13	Meningioma of the olfactory groove, case 2, Fig. 14