A Frontal Dural‐Based Lesion in a 63‐Year Old Male

Abstract

A 63-year old male presented to a neurosurgeon with a firm, immobile, non-tender mass of his right supraorbital forehead. The patient endorsed remote (×40 years) trauma to the area with subsequent bony irregularity, with recent (×3 months) subtle enlargement. There was no associated neurologic symptom and his physical exam was negative for neurologic deficits. Imaging revealed a 3.9-centimeter dural-based lesion with osseous extension involving both inner and outer table; there was a dural tail with enhancement, but not bulky intracranial extension. A frontal craniotomy with tumor resection including wide dural excision was performed at an outside institution. The pathologic diagnosis rendered was meningioma; there was disagreement regarding whether to classify the neoplasm as 'atypical'. No adjuvant therapy was administered. Three years later the lesion recurred in the midline, adjacent to the resection site ( Figure 1A, Axial T1-weighted MRI with contrast enhancement), and the patient presented to Moffitt Cancer Center for further neurosurgical management. The tumor was resected and the diagnosis was unchanged at that time. The tumor recurred and was re-excised two years later, prompting re-evaluation of the case. A fourth operation was undertaken the following year, six years after the initial presentation; histomorphology was unchanged.