Presentation
Generalized tonic clonic seizure.
Patient Data
A large, peripherally located (probably extra-axial) mass is present which demonstrates vivid contrast enhancement and adjacent edema.
A large vividly enhancing extra-axial mass with peritumoural cysts (with enhancing cysts suggesting they are part of the tumor) is demonstrated with extensive associated edema.
A vascular tumor with morphology consistent with meningioma supplied predominantly by the right anterior division of the middle meningeal artery. Additional supply from distal middle cerebral artery branches.
Note the enhancement of the tumor is early compared to other vessels and stays late. This has been referred to, perhaps unkindly, as a mother-in-law sign.
Embolization:
A 6Fr guiding catheter was placed in the proximal ECA. The middle meningeal artery was selected using a microcatheter. The tumor was embolized using 15-250 micron PVA particles.
This resulted in a significant reduction in the vascularity of the tumor. MCA supply was not embolized. No embolic complication.
Case Discussion
The patient went on to have surgery, confirming a cystic meningioma.
Histology
The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumor forms whorls. No sheeting arrangement is seen. The tumor cells have ovoid nuclei with no nuclear pleomorphism.
Foreign body material is present within a few blood vessels, consistent with preoperative embolization. Mitoses are inconspicuous. There is no necrosis. No brain parenchyma is seen. No evidence of atypical or malignant change is identified. The dural edges appear clear.
Final diagnosis: meningioma (WHO Grade I).
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