Primary Intraosseous Meningioma; Case Report And Management In KNH

Abstract

Background: Intraosseous meningioma is a rare entity that may mimic other skull lesions.  It is thought to result from rests of arachnoid cap cells within skull sutures during development and is also associated with skull trauma. Case presentation: We present a 65yr old man who presented with vertex scalp swelling for 8 years. This was painless with no skin changes but reported as disfiguring to the point of affecting his self image. He had remote history of head trauma some years prior to onset. Associated seizures for 1year and left hemiparesis for 3months was reported. His KPS was 80%. Physical examination revealed a hard vertex swelling that was non-tender, non-pulsatile skull swelling measuring 14*10cm.  No attachment to overlying skin. Left hemiparesis MRC 4/5 all muscle groups with hyperreflexia with no other deficits. CT scan revealed a hyperdense large vertex tumor with both hyperostosis and lytic areas. Extension to the scalp and extradural space was also evident with areas of calcification. MRI with MRA showed intradural component and pial invasion with homogenous contrast enhancement, prominent flow voids with occlusion of sagittal sinus and collateral draining veins. Tumor resection comprising of the abnormal calvarium, dura and the extracranial component was done followed by cranioplasty and duraplasty.  Histology showed meningothelial meningioma WHO Grade 1. The patient had remarkable progress post operatively with good functional outcome. Conclusion: Intraosseous meningioma involving the calvaria are rare and may mimic other osseous lesions. Surgical resection with cranial reconstruction is the treatment of choice and provides tissue for definitive diagnosis.