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Typical meningioma, convexity

CLINICAL HISTORY:
This 43-year old man suffered a grand mal seizure. For 6 weeks he complained of paresthesia of the right hand.

NEUROLOGICAL EXAMINATION is normal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): A slightly hyperdense mass is seen (arrowheads) in the left parietal region with broad contact with the convexity.

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

MRI:
a) TRANSAXIAL T2-WEIGHTED (3800/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): A well-defined mass is seen (arrowheads) at the left parietal convexity, with broad implantation on the dura. The mass is inhomogeneously hyperintense.

b) TRANSAXIAL T1-WEIGHTED (600/14/1) SPIN-ECHO SEQUENCE (IMAGE 4): The mass is hypointense (arrowheads).

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: Intense and homogeneous enhancement of the lesion is noted (arrowheads), except for a small anterior cyst. Broad implantation on the convexity is seen as a circumferential dural tail (arrow).

ANGIOGRAPHY: Selective injection of the left internal carotid artery in the lateral projection (IMAGE 8) and external carotid artery in the anteroposterior (IMAGE 9) and lateral (IMAGE 10) projection. The tumor is supplied by the middle meningeal and superficial temporal artery, and is highly vascular. Parenchymal insertion of the tumor (arrowheads) is supplied by pial vessels of the internal carotid artery.

RADIOLOGICAL DIAGNOSIS: is meningioma, based on the extraaxial location, the broad implantation on the dura, the intense enhancement and the dural tail.

SURGICAL FINDINGS: At surgery, a 3.5 cm diameter tumor was found with broad implantation on the dura mater. The tumor was highly vascular.

ANATOMOPATHOLOGY was consistent with meningioma.

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Meningioma

 

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Fig. 1

Typical meningioma, convexity, Fig. 1
Typical meningioma, convexity, Fig. 2
Typical meningioma, convexity, Fig. 3
Typical meningioma, convexity, Fig. 4
Typical meningioma, convexity, Fig. 5
Typical meningioma, convexity, Fig. 6
Typical meningioma, convexity, Fig. 7
Typical meningioma, convexity, Fig. 8
Typical meningioma, convexity, Fig. 9
Typical meningioma, convexity, Fig. 10