Zou Mingang, Yang Ruijin, Tang Zhiji, Luo Defang, Jiang Qiuhua
Department of Neurosurgery, Ganzhou People's Hospital, Ganzhou, China.
Front Surg. 2022 Oct 18;9:995986. doi: 10.3389/fsurg.2022.995986. eCollection 2022.
Primary intraosseous meningiomas (PIOMs) are a rare subset of meningiomas, comprising fewer than 1% of all such tumors. Furthermore, PIOMs presenting as osteogenic lesions that invade both the dura and subcutaneous tissue are extremely rare. Unlike intracranial meningiomas, diagnosing and treating PIOMs are challenges due to their insidious clinical behavior and a lack of clear radiological diagnostic criteria. We report the case of a 60-year-old female with headache and a slightly outward protrusion of the parietal region of the skull. CT showed an osteogenic lesion in the right parietal bone. MR imaging indicated mild to moderate homogeneous enhancement with an intense dural reaction. The suggested clinical diagnosis was lymphoma, so we performed a skull biopsy, which revealed an intraosseous benign meningioma. A precise resection strategy was planned with a neuronavigation system accompanied by a one-step customized titanium mesh cranioplasty. The lesion was completely removed, and pathological analysis confirmed a meningothelial meningioma (WHO Grade I) of intraosseous layer origin invading the dura mater and subcutaneous tissue. This case highlights the need for an initial biopsy when the lesion is difficult to diagnose on imaging. Complete resection should be attempted to minimize the risk of recurrence.
原发性骨内脑膜瘤（PIOMs）是脑膜瘤的一个罕见亚型，占所有此类肿瘤的比例不到1%。此外，表现为侵袭硬脑膜和皮下组织的成骨性病变的PIOMs极为罕见。与颅内脑膜瘤不同，由于其隐匿的临床行为和缺乏明确的放射学诊断标准，PIOMs的诊断和治疗具有挑战性。我们报告一例60岁女性病例，患者有头痛症状，颅骨顶叶区域有轻微向外突出。CT显示右侧顶骨有成骨性病变。磁共振成像显示轻度至中度均匀强化，伴有强烈的硬脑膜反应。临床初步诊断为淋巴瘤，因此我们进行了颅骨活检，结果显示为骨内良性脑膜瘤。我们使用神经导航系统并结合一步定制钛网颅骨成形术制定了精确的切除策略。病变被完全切除，病理分析证实为起源于骨内层的脑膜上皮型脑膜瘤（WHO一级），侵袭硬脑膜和皮下组织。该病例强调了在影像学上难以诊断病变时进行初始活检的必要性。应尝试完整切除以将复发风险降至最低。
