Giant Meningioma of the Cranial Vertex. Case Report.

Abstract

A 55-year-old man was admitted with a swelling on the top of his head progressively growing for 2 years. The swelling had grown to a huge size with the appearance of a double head. A huge meningioma with predominantly extracranial growth and invasion into the superior sagittal sinus was subtotally excised. The excised tumor mass weighed 1380 g. The residual tumor was treated by irradiation. No recurrence was seen at one-year follow-up examination.

Extracranial primary and secondary meningiomas

“…If possible, this has to be accompanied by removal of an adequate margin of normal bone. A dural defect can be closed using pericranium harvested from the adjoining region or, alternatively, a vascularized pedicle pericranial flap can be used 19 . At surgery, the skin can be separated from the temporalis fascia easily.…”

Massive intra and extracranial benign meningioma metastasizing to the lung and spine: the problem of meningiomas classification and iatrogenic metastasizing

“…Massive meningiomas are rare with decreasing incidence as health care improves and health conscience increases. 25 In a literature review Nadkarni et al 25 report massive meningiomas weighting from 375 to 2,600 g. Massive meningiomas are usually of benign histology and unlike the case reported here rarely metastasize. However, as metastases in meningioma are often asymptomatic and seldom the cause of death 24 this thesis could be questioned, especially as most of the patients with massive meningioma reported in literature never underwent screening for metastasis with modern techniques.…”

“…18 Anaplastic meningiomas display frank cranial growth of many massive meningiomas. 25 Hence massive meningiomas grow osteolyticly which occurs in 10%-17%. 26 Both Nadkarni et al 25 and Yamada et al 26 recommend considering bone-invasive meningiomas as malignant, the former by comparing meningioma to other intracranial tumors and by presenting a case in which the extracranial portion on a massive meningioma has a higher MIB-1 labelling index than the intracranial portion.…”

Hydrocephalus Following Giant Transosseous Vertex Meningioma Resection

“…2 While usually benign, meningiomas can become highly invasive and involve the intraosseous and extracalvarial spaces. While there have been several prior reports of large transosseous and extracalvarial meningiomas, there is relatively limited discussion of the surgical repercussions from resecting these meningiomas, [3][4][5] We have found no prior reports of postoperative hydrocephalus that required CSF diversion in this tumor population. Herein, we report a series of four patients that presented with giant-sized (defined as greater than 6 cm) vertex transosseous meningiomas.…”

“…However, there have only been limited case reports regarding the subset of large, vertex-based, meningiomas. 3,5 In the present work, we add to this limited literature by presenting a series of four cases of large, vertex-based, meningiomas. To the best of our knowledge, this may be the first discussion of the development of external hydrocephalus following surgical resection of these large lesions.…”