Parasagittal Meningioma Differential Diagnosis

Parasagittal Meningioma Differential Diagnosis

see also Meningioma Differential Diagnosis.


Intracerebral schwannoma 1) 2) 3) 4).

Extra-axial ependymoma 5) 6).

Fibrous histiocytoma 7).

Rosai-Dorfman disease 8).


A 14-year-old female mosaic for the de novo p.R108H pathogenic variant in the PIK3CA gene was found to have a large tumor involving the superior sagittal sinus with mass effect on the motor cortex most consistent with a parafalcine meningioma. She underwent surgical resection with pathology demonstrating a venous malformation. PIK3CA pathogenic variants have been identified in nonsyndromic extracranial venous and lymphatic malformations as well in brain tumors, including glioma and meningioma. However, PIK3CA variants have not previously been identified in purely intracranial venous malformations. This distinction is relevant to treatment decisions, given that mTOR inhibitors may provide an alternative option for noninvasive therapy in cases of suspected venous malformation 9).


1)

Li M, Mei J, Li Y, Tao X, Hong T. Intracerebral schwannoma mimicking meningioma: case report. Can J Neurol Sci. 2013 Nov;40(6):881-4. PubMed PMID: 24257236.
2)

Ma L, Yang SX, Wang YR. Intracerebral schwannoma mimicking parasagittal meningioma. J Craniofac Surg. 2013 Nov;24(6):e541-3. doi: 10.1097/SCS.0b013e31828601bf. PubMed PMID: 24220461.
3)

Bristol RE, Coons SW, Rekate HL, Spetzler RF. Invasive intracerebral schwannoma mimicking meningioma in a child. Childs Nerv Syst. 2006 Nov;22(11):1483-6. Epub 2006 Sep 22. PubMed PMID: 17021734.
4)

Takei H, Schmiege L, Buckleair L, Goodman JC, Powell SZ. Intracerebral schwannoma clinically and radiologically mimicking meningioma. Pathol Int. 2005 Aug;55(8):514-9. PubMed PMID: 15998381.
5)

Singh V, Turel MK, Chacko G, Joseph V, Rajshekhar V. Supratentorial extra-axial anaplastic ependymoma mimicking a meningioma. Neurol India. 2012 Jan-Feb;60(1):111-3. PubMed PMID: 22406799.
6)

Salunke P, Kovai P, Sura S, Gupta K. Extra-axial ependymoma mimicking a parasagittal meningioma. J Clin Neurosci. 2011 Mar;18(3):418-20. doi: 10.1016/j.jocn.2010.04.042. Epub 2011 Jan 13. PubMed PMID: 21236682.
7)

Tsutsumi M, Kawano T, Kawaguchi T, Kaneko Y, Ooigawa H, Yoshida T. Intracranial meningeal malignant fibrous histiocytoma mimicking parasagittal meningioma–case report. Neurol Med Chir (Tokyo). 2001 Feb;41(2):90-3. PubMed PMID: 11255634.
8)

Kattner KA, Stroink AR, Roth TC, Lee JM. Rosai-Dorfman disease mimicking parasagittal meningioma: case presentation and review of literature. Surg Neurol. 2000 May;53(5):452-7; discussion 457. Review. PubMed PMID: 10874144.
9)

Filippidis A, Lidov H, Al-Ibraheemi A, See AP, Srivastava S, Orbach DB, Fehnel KP. Intracranial venous malformation masquerading as a meningioma in PI3KCA-related overgrowth spectrum disorder. Am J Med Genet A. 2021 Dec 2. doi: 10.1002/ajmg.a.62570. Epub ahead of print. PMID: 34854542.

Atypical meningioma

Atypical meningioma (AM)

Atypical meningioma (World health organization grade 2 meningioma) comprise a heterogeneous group of tumors, with histopathology delineated under the guidance of the WHO and a spectrum of clinical outcomes.

Atypical Meningioma Epidemiology

Intracranial atypical meningiomas

Spinal atypical meningiomas.

Atypical Meningioma Pathology.

see Atypical meningioma diagnosis.

Atypical meningioma Differential Diagnosis

see Atypical meningioma treatment.

see Atypical meningioma outcome.

Atypical meningioma case series.

Atypical meningioma case reports.

Convexity meningioma surgery

Convexity meningioma surgery

Convexity meningioma surgery indications.

Preoperative embolization of intracranial meningioma.

see Surgical safety checklist.

see Preoperative antibiotic prophylaxis.

see Skin Preparation.

For convexity meningioma, the head is positioned so that the center of the tumor is uppermost, the same position as described for parasagittal tumors or for tumors close to the midline.

The incision and bone flap must be large enough to allow for excision of a good margin of dura around the tumor attachments.

The meningeal arteries are occluded as they are exposed.

These tumors can be removed intact by placing gentle traction on the dural attachment and working circumferentially around the tumor to divide the attachments to the cortex. However, if the surface of the tumor cannot be easily visualized without placing significant retraction on the cortex, internal decompression of the tumor is done and the capsule is reflected into the area of decompression.

In a situation where the tumor arises over the frontal temporal junction and grows into the sylvian fissure, the medial capsule and the dural attachment may extend down onto the lateral floor of the anterior fossa and anterior wall of the middle fossa, and the medial capsule of the tumor can be attached to branches of the middle cerebral artery.

A study showed that meningioma recurrence was unlikely when autologous cranioplasty was done with refashioned hyperostotic bone. This could be done in the same setting with meningioma excision. There was no recurrence at a mean of 5-year follow-up in convexity meningiomas 1).

Right Convexity Meningioma from Surgical Neurology International on Vimeo.

Left Frontal Convexity Meningioma from Surgical Neurology International on Vimeo.

An accurate and real-time model of soft tissue is critical for surgical simulation for which a user interacts haptically and visually with simulated patients. A paper focuses on the real-time deformation model of brain tissue for the interactive surgical simulation, such as neurosurgical simulation.

A new Finite Element Method (FEM) based model with constraints is proposed for the brain tissue in neurosurgical simulation. A new energy function of constraints characterizing the interaction between the virtual instrument and the soft tissue is incorporated into the optimization problem derived from the implicit integration scheme. Distance and permanent deformation constraints are introduced to describe the interaction in the convexity meningioma dissection and hemostasis. The proposed model is particularly suitable for GPU-based computing, making it possible to achieve real-time performance.

Simulation results show that the simulated soft tissue exhibits the behaviors of adhesion and permanent deformation under the constraints. Experiments show that the proposed model is able to converge to the exact solution of the implicit Euler method after 96 iterations. The proposed model was implemented in the development of a neurosurgical simulator, in which surgical procedures such as dissection of convexity meningioma and hemostasis were simulated 2).


1)

Lau BL, Che Othman MI, Fakhri M, San Liew DN, San Lim S, Bujang MA, Hieng Wong AS. Does putting back hyperostotic bone flap in meningioma surgery causes tumor recurrence? An observational prospective study. World Neurosurg. 2019 Mar 26. pii: S1878-8750(19)30863-0. doi: 10.1016/j.wneu.2019.03.183. [Epub ahead of print] PubMed PMID: 30926555.
2)

Hou W, Liu PX, Zheng M. A new model of soft tissue with constraints for interactive surgical simulation. Comput Methods Programs Biomed. 2019 Jul;175:35-43. doi: 10.1016/j.cmpb.2019.03.018. Epub 2019 Apr 1. PubMed PMID: 31104713.
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