Parapharyngeal meningioma extending from the intracranial space

Abstract

A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated.

Primary meningiomas of the jugular fossa

“…4,8,9,18,19,23,24,[31][32][33][35][36][37][38]42,46,47,50,51,[54][55][56][57] The mean age of our patients, 49 years, is also higher than that listed in other reported cases (mean 32 years). 4,8,9,18,19,23,24,[31][32][33][34][35][36][37][38]42,46,47,50,51,[54][55][56][57] Up to 20% of all intracranial meningiomas eventually extend extracranially. Although other locations are more common for these extensions (orbit and the external table of the calvaria, followed by the nasal cavity and the paranasal sinuses), the meningioma invades the parapharyngeal space through either the foramen lacerum or the jugular fossa.…”

“…[1][2][3][4][5][6][7][8][9][10][11][12][16][17][18][19][20][21][22][23][24][25][26][27][28][31][32][33][34][35][36][37][38][39][40][42][43][44][45][46][47][48][49][50][51][54][55][56][57][58][59] Possibly more so than in any other skull base surgery, the approach to a JFM should be tailored to each patient.…”

“…12,21,32,33,36,45 Because of the impreciseness of such a broad subgrouping, JFMs were later separated into their own subgroup. 1,8,9,18,19,23,24,[31][32][33][34][35][36][37][38]42,46,47,50,51,[54][55][56] To date, fewer than 40 cases of JFMs have been published. 4,8,9,18,19,23,24,[31][32][33][34][35][36][37][38]42,46,47,50,51,[54][55][56]…”

Imaging Features of Extra Cranial Parapharyngeal Space Meningioma: Case Report

“…Histopathology of our case revealed psammoma bodies suggestive of meningotheliomatous (transitional or psammomatous form) meningioma (Figure 12). Most of the meningiomas are treated surgically with the aim to remove the whole of the tumor along with the dural attachment and bone [13]. The most important prognostic factor in meningioma depends upon the completeness of the surgery.…”

Retropharyngeal meningioma is a rare cause of acute respiratory distress

“…Extracranial meningiomas occurring in the region of the base of the skull are frequently associated with lower cranial nerve palsies 3, 4, 5, 6 . Respiratory distress has not been reported as a symptom of extracranial meningioma before.…”