Primary intraosseous meningioma in a skull of the medieval period of Southwestern Germany

Abstract

Primary intraosseous calvarial meningiomas are very rare entities in recent times. We present the first case in antiquity of a primary intraosseous meningioma in the frontoparietal bone associated with the coronal suture, and discuss its pathology. The skull derives from southwestern Germany and is dated to the 12th-14th centuries AD. The lesion is interpreted as a solitary osteoblastic neoplasm with hyperostosis on the outside, and osteolysis and radial spiculation in the central part of the lesion with an area of irregularity along the inner table. In cases of solitary osteoblastic skull lesions the differential diagnosis comprises: fibrous dysplasia, osteoma, osteoblastic metastasis, Pagets disease and meningioma with sheet-like growth along the dural surface with marked hyperostosis (called meningioma en plaque). We believe that a differentiation between hyperostotic meningioma en plaque and intraosseous meningioma cannot be made in skulls from antiquity.

Primary intraosseous osteolytic meningioma without an evidence of soft tissue invasion

“…This neoplasm has no gender predilection, and it has two peaks of incidence in the second decade and between the fifth and seventh decades with a median age of 40‐49 years, 5 and this is consistent with our patient who presented with 45 years old. The most common locations are the convexity and skull base 6 .…”

Neurosurgical aspects of trepanations from Neolithic times

“…menigiomas), infection (e.g. syphilis or tuberculosis), partial bone osteopenia, tangential sword cuts, gnawing by animals, postmortem perforation, and damage during excavation (Lisowski, 1967;Powell, 1970;Aufderheide, 1985;Jordanov et al, 1888, Weber & Czarnetzki, 2002Weber et al, 2004). There are no such conditions for our skulls from the Neolithic period (Figures 1 and 2).…”

Skull deformations in craniosynostosis and endocrine disorders

“…The shape of this structure seemed similar to epidural hematoma (fusiform, lentiform -shape of biconvex lens). These can produce sulci for pathologically widened blood vessels, which are associated with arachnoid granulations (Smrčka et al, 2003;Waldron, 1998) as well as hypertrophic and osteolytic lesions (Weber and Czarnetzki, 2002). No such lesions were observed on the bones in the analyzed skull.…”