Malca S A, Roche P H, Thomassin J M, Pellet W
Service de Neurochirurgie, Hôpital Sainte-Marguerite, Marseille.
Neurochirurgie. 1994;40(2):96-108.
Primary ectopic meningiomas are uncommon. The authors report a case of a 12-year-old boy with a meningioma presenting as a neck mass. The conclusion of the initial biopsy was chemodectoma, but on surgical resection, the tumour was found to have invaded the petrous bone. Post-operative follow-up was uneventful but magnetic resonance imagery revealed extension to the cerebello-pontine angle, the cavernous sinus, the tentorium and the falx. The authors discuss the main pathogenic hypotheses and the classification of ectopic meningiomas. Based on 62 similar cases reported in the literature, primary ectopic meningiomas are found most often in young subjects, with no female predominance, neurofibromatosis is often observed and angioblastic or malignant features are frequent. These tumours can be divided into 6 localizations (jugulo-carotid space, lymph nodes, parotid gland, thyroid gland, soft paravertebral tissues, skin) and into 3 pathogenic groups (solitary ectopic tumour of the neck, tumour of the neck connected to a cranial or spinal meningioma, metastasis). Meningioma of the jugulo-carotid space with connection to the skull base is the most frequent entity. Solitary ectopic meningiomas of the neck occur in only 1 out of 5 cases. In 2 out of 3 cases, the neck localization involves a connection to a cranial or spinal meningioma. In a few cases the neck mass is a metastasis. These findings suggest that a complete neuroradiological work-up is required. Prognosis depends on the completeness of the surgical resection and the histologic aggressiveness frequently encountered.
原发性异位脑膜瘤并不常见。作者报告了一例12岁男孩,其脑膜瘤表现为颈部肿块。最初活检的结论是化学感受器瘤,但手术切除时发现肿瘤已侵犯岩骨。术后随访情况良好,但磁共振成像显示肿瘤已延伸至小脑脑桥角、海绵窦、小脑幕和大脑镰。作者讨论了异位脑膜瘤的主要致病假说和分类。根据文献报道的62例类似病例,原发性异位脑膜瘤最常发生于年轻患者,无女性优势,常观察到神经纤维瘤病,且血管母细胞性或恶性特征较为常见。这些肿瘤可分为6个部位(颈静脉 - 颈动脉间隙、淋巴结、腮腺、甲状腺、椎旁软组织、皮肤)和3个致病组(颈部孤立性异位肿瘤、与颅或脊膜瘤相连的颈部肿瘤、转移瘤)。与颅底相连的颈静脉 - 颈动脉间隙脑膜瘤是最常见的类型。颈部孤立性异位脑膜瘤仅占5例中的1例。在3例中有2例,颈部病变涉及与颅或脊膜瘤相连。少数情况下,颈部肿块是转移瘤。这些发现表明需要进行全面的神经放射学检查。预后取决于手术切除的完整性以及常遇到的组织学侵袭性。