Zhang Hai-Bo, Zhan Yi-Ping, Yu Xin-Guang
From the *Institute of Neurosurgery, Chinese PLA General Hospital; and †Department of Neurosurgery, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
J Craniofac Surg. 2014 Jul;25(4):1544-6. doi: 10.1097/SCS.0000000000000792.
Papillary meningioma is an uncommon meningioma subtype of World Health Organization grade III. It could show some radiologic profiles pointing to malignant behavior, such as a cystic change, a heterogeneous enhancement, and an ill- defined border. However, to date, the radiologic profile described in this article has not been reported in previous literatures, and it is just the characteristic being considered as the major cause for patients' death. A 16-year-old adolescent boy with a 6-month history of headache was admitted to our department on June 28, 2012. Magnetic resonance imaging showed a giant well-defined mass in the left temporal region, with a severe flow void on T2-weighted image and an abundant stripelike enhancement on T1-weighted contrast-enhanced scan. In view of its middle cranial fossa location (one predilection site for meningioma), meningioma was suspected preoperatively. A regular left frontotemporal craniotomy was performed. Unexpectedly, extreme hemorrhage happened intraoperatively, and it was difficult to stop the bleeding. After identification of no hemorrhage in the operative cavity through intraoperative magnetic resonance imaging, the operation was finished, with an overall blood loss of 15,000 mL. The patient died of brain stem dysfunction the second day after the operation.
乳头状脑膜瘤是世界卫生组织III级的一种罕见脑膜瘤亚型。它可能表现出一些提示恶性行为的影像学特征，如囊性改变、不均匀强化和边界不清。然而，迄今为止，本文所描述的影像学特征在以往文献中尚未见报道，而这一特征恰恰被认为是导致患者死亡的主要原因。一名16岁青少年男性，有6个月头痛病史，于2012年6月28日入住我科。磁共振成像显示左侧颞区有一个边界清晰的巨大肿块，T2加权像上有明显的流空信号，T1加权增强扫描有丰富的条状强化。鉴于其位于中颅窝（脑膜瘤的一个好发部位），术前怀疑为脑膜瘤。行常规左额颞开颅手术。术中意外发生大量出血，难以止血。通过术中磁共振成像确认术腔无出血后，手术结束，总失血量达15000毫升。患者术后第二天死于脑干功能障碍。
