Vescovi Maria Caterina, Bagatto Daniele, Capo Gabriele, Maieron Marta, Marin Dario, Pegolo Enrico, Tomasino Barbara
Department of Neurosurgery, AOU-UD Santa Maria della Misericordia, Udine, Italy.
Department of Neuroradiology, AOU-UD Santa Maria della Misericordia, Udine, Italy.
Pediatr Neurosurg. 2018;53(3):175-181. doi: 10.1159/000487808. Epub 2018 Apr 12.
Intraparenchymal meningiomas are very rare: only 26 cases have been diagnosed in patients younger than 20 years since 1954. They can lead to preoperative differential diagnosis mistakes due to their atypical neuroimaging appearance. A multimodal approach is thus necessary to plan a surgical procedure aiming to receive the best extent of resection while preserving the patient's functional integrity. The authors report the case of a 7-year-old boy with a history of blurred vision, left eye deviation, and weakness on the left side of his body. Magnetic resonance imaging (MRI) revealed an intra-axial, cortical, right parietal lesion without dural attachment. MR spectroscopy and perfusion study were obtained. Since the patient was 100% left-handed, functional MRI, diffusion tensor imaging, and neuropsychological evaluation were performed before the surgical procedure. Histopathological analysis revealed the mass to be an atypical meningioma (WHO grade II). Postoperative MRI indicated complete macroscopic lesion removal. The postsurgical neuropsychological profile was not different from the profile before surgery. The boy was discharged 3 days after the surgical operation without any neurological deficits.
自1954年以来，20岁以下患者中仅诊断出26例。由于其非典型的神经影像学表现，它们可能导致术前鉴别诊断错误。因此，需要一种多模式方法来规划手术程序，旨在在保留患者功能完整性的同时获得最佳切除范围。作者报告了一例7岁男孩的病例，该男孩有视力模糊、左眼偏斜和身体左侧无力的病史。磁共振成像（MRI）显示轴内、皮质、右顶叶病变，无硬脑膜附着。进行了磁共振波谱和灌注研究。由于该患者是100%左利手，在手术前进行了功能MRI、弥散张量成像和神经心理学评估。组织病理学分析显示肿块为非典型脑膜瘤（世界卫生组织II级）。术后MRI显示宏观病变完全切除。术后神经心理学表现与手术前无异。该男孩在手术后3天出院，无任何神经功能缺损。
