Yaohua S, Kidooka M, Okada T, Nakasu S
Division of Neurosurgery, Dai-ni Okamoto Hospital, Kyoto, Japan.
Nihon Geka Hokan. 1992 May 1;61(3):268-73.
A case of cystic falx meningioma in the frontal region in which preoperative neuroradiologic diagnosis was difficult is reported. This 33-year-old man had suffered from epileptic seizures three times in one month. Physical and neurological examinations on admission were normal. A cystic mass with a small nodule was found on CT in the frontal region. Thin wall was enhanced smoothly and the nodule attached to the falx was enhanced heterogeneously. The mass was considered to be an extra-axial lesion on MRI. The right anterior falcine artery seemed to feed the mass. Bifrontal craniotomy was performed. Cyst was evacuated, and a soft reddish mass was subtotally removed. Cyst fluid was yellowish and protein content was 3.5 g/dl. Histopathological diagnosis was a meningotheliomatous meningioma and tumor cells were present also in the thin cyst wall. At the second operation the mass was completely removed, cyst wall inclusive. When we encounter a cystic mass in the sites of predilection of meningiomas, we have to consider the possibility of a cystic meningioma. If the mass has meningeal vascularization, a correct diagnosis is not difficult. Taking the location of the mass into consideration, an accurate interpretation of CT and MRI findings indicating extra-axial nature of the mass is indispensable.
报告一例术前神经放射学诊断困难的额叶囊性镰旁脑膜瘤病例。该33岁男性在一个月内癫痫发作三次。入院时体格检查和神经系统检查均正常。CT检查发现额叶有一个带有小结节的囊性肿块。薄壁呈光滑强化，附着于镰的结节呈不均匀强化。MRI显示该肿块为脑外病变。右前镰旁动脉似乎为肿块供血。行双额开颅手术。抽出囊肿内容物，次全切除一个软的淡红色肿块。囊液呈淡黄色，蛋白质含量为3.5g/dl。组织病理学诊断为脑膜皮型脑膜瘤，薄的囊肿壁内也有肿瘤细胞。在第二次手术中，完整切除了肿块，包括囊肿壁。当我们在脑膜瘤好发部位遇到囊性肿块时，必须考虑囊性脑膜瘤的可能性。如果肿块有脑膜血管化，正确诊断并不困难。考虑到肿块的位置，准确解读CT和MRI显示肿块脑外性质的表现是必不可少的。
