1/84. Primary lymphoma of Meckel's cave mimicking trigeminal schwannoma: case report.OBJECTIVE AND IMPORTANCE: We report the first case of primary lymphoma of Meckel's cave. The ability of a lymphoma to mimic a trigeminal schwannoma, both clinically and radiographically, resulted in misdiagnosis and flawed surgical strategy. We discuss the characteristics of a Meckel's cave lymphoma on magnetic resonance images, the predisposing medical conditions that should cause the neurosurgeon to add lymphoma to the normal differential diagnosis, and appropriate management strategies. CLINICAL PRESENTATION: A 40-year-old African-American woman presented with a 5-month history of progressive facial numbness and pain in all three divisions of the left trigeminal nerve. magnetic resonance imaging revealed a mass in the left side of Meckel's cave, with extension into the lateral compartment of the cavernous sinus, without encasement of the internal carotid artery, through the foramen rotundum into the posterior aspect of the maxillary sinus, and through the foramen ovale into the pterygopalatine fossa. The diagnosis, based on clinical history and radiographic imaging, was schwannoma of Meckel's cave. The patient had a history of systemic lupus erythematosus that had been treated with intermittent steroid therapy. INTERVENTION: The surgical approach selected was a frontotemporal craniotomy with orbitozygomatic osteotomy and anterior petrosectomy. The lesion was totally excised, although the gross intraoperative appearance of the lesion was inconsistent with the preoperative diagnosis, and the pathological examination was unable to establish a histological diagnosis on the basis of frozen sections. Histological diagnosis was confirmed on permanent section after surgery as B-cell lymphoma. Evaluation for other primary sites produced negative results. The patient was then treated with cyclophosphamide (Cytotoxan; Bristol-Myers Oncology, Princeton, NJ), doxorubicin (Adriamycin; Pharmacia & Upjohn, Kalamazoo, MI), vincristine, and prednisone chemotherapy every 3 weeks for six cycles and then by radiation therapy to the affected area. CONCLUSION: The diagnosis of lymphoma should be considered for lesions affecting Meckel's cave in high-risk immunocompromised patients. The presence of an apparent dural tail in an otherwise typical schwannoma is the distinguishing characteristic of a lymphoma. The absence of hyperostosis helps differentiate it from a meningioma. At this point, the preferred surgical strategy is biopsy for diagnosis and then radiotherapy and chemotherapy rather than major cranial base surgery for total resection.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
2/84. Intracanalicular meningioma.Intracanalicular meningiomas are extremely rare and difficult to differentiate from intracanalicular vestibular schwannomas. We report an unusual case of a posterior fossa meningioma in the proximal internal auditory canal that was originally diagnosed as a vestibular schwannoma due to its appearance on magnetic resonance imaging. However, closer inspection of the preoperative neuroimages revealed features inconsistent with vestibular schwannoma that suggested the possibility of other less common lesions.- - - - - - - - - - ranking = 6.218471513317keywords = meningioma, meningiomas (Clic here for more details about this article) |
3/84. Primary meningioma of the fallopian canal.Meningiomas are slow-growing lesions that represent approximately 20% of all intracranial tumors and are the second most common tumor of the cerebellopontine angle. In contrast, primary extracranial meningiomas are found relatively infrequently, and most cases have inadequate radiologic studies to determine if they were actually an extension from a primary intracranial source. Meningiomas of the intratemporal segment of the facial nerve have also been reported, but they are exceedingly rare and their pathophysiology remains unclear. We report a case of a meningioma of the facial nerve in the fallopian canal of a 7-year-old girl and review pertinent literature.- - - - - - - - - - ranking = 6.218471513317keywords = meningioma, meningiomas (Clic here for more details about this article) |
4/84. Oral ulcerations as the first sign of a foramen magnum meningioma.We report the case of a patient with oral ulcerations that were likely traumatic in origin caused by biting of the tongue. physical examination showed only deviation, fasciculations, and hemiatrophy of the right side of the tongue. neurologic examination disclosed an isolated XII nerve palsy. A magnetic resonance image showed a lesion in the posterior fossa displacing the brain stem at a bulbar level. This was consistent with the diagnosis of a meningioma, later confirmed by the histopathologic study. It is very unusual that a meningioma produces a selective involvement of the XII nerve. early diagnosis of a foramen magnum meningioma is important, both to improve prognosis and to avoid neurologic sequelae.- - - - - - - - - - ranking = 7keywords = meningioma (Clic here for more details about this article) |
5/84. Cranial nerve root entry zone primary cerebellopontine angle gliomas: a rare and poorly recognized subset of extraparenchymal tumors.With the exception of patients with neurofibromatosis type II, pediatric extraparenchymal cerebellopontine angle (CPA) tumors of any sort are extremely rare. Most gliomas encountered in the CPA in either children or adults involve the CPA as exophytic extensions of primary brain stem and/or cerebellar tumors. We encountered an unusual case of a giant CPA pilocytic astrocytoma arising from the proximal trigeminal nerve, completely separate from the brain stem. A nine-year-old girl with no evidence for any neurocutaneous syndrome, presented with headaches, mild obstructive hydrocephalus, trigeminal hypesthesia and a subtle peripheral facial paresis. Pre-operative neuroimaging suggested a petroclival meningioma. The tumor was completely resected via a right pre-sigmoid, retro-labyrinthine, subtemporal, transtentorial ('petrosal') approach, using intraoperative neurophysiological monitoring, with minimal morbidity. This appears to be the first reported case of a pediatric primary CPA glioma and the seventh reported case of primary CPA glioma, overall. It represents the second reported case of a primary CPA pilocytic astrocytoma. Given the findings in this case and the six other cases of primary CPA gliomas reported in the literature, as well as the results of histological studies of normal cranial nerves, we hypothesize that the point of origin of these rare and unusual tumors is the root entry zone of the involved cranial nerves. The differential diagnosis of primary CPA tumors should be expanded to include cranial nerve root entry zone primary CPA gliomas.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
6/84. Solitary fibrous tumor of the hypoglossal nerve.Summary: We report a case of solitary fibrous tumor (SFT) causing isolated hypoglossal nerve palsy. The neuroimaging appearance of the tumor was indistinguishable from that of schwannoma or meningioma. Immunohistochemical tests demonstrated strong reactivity for CD34 but an absence of staining for S100 and epithelial membrane antigen; this profile is indicative of an SFT. SFTs are mesenchymal tumors that can affect the dura-covered segments of cranial nerves. They may be considered in the differential diagnosis of an isolated cranial nerve palsy.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
7/84. Bilateral meningiomatous lesions of the spinal accessory nerves.BACKGROUND: Meningiomas arising from cranial nerves with no dural attachment are exceedingly rare. The authors present a patient with bilateral meningiomatous lesions originating symmetrically from both spinal accessory nerves. CASE REPORT: A 61-year old woman presented with a one-year history of spinal ataxia and minimal left-sided motor impairment. magnetic resonance imaging demonstrated two extrinsic lesions dorsolaterally of the medulla. Surgical exposure via a midline suboccipital approach with C1 laminectomy revealed the lesions arising from the spinal accessory nerves and in direct contact with the vertebral arteries. Histological investigation showed hypocellular fibrous lesions with proliferating meningothelial cells, psammoma bodies and immunoreactivity for vimentin, S-100 protein and epithelial membrane antigen. INTERPRETATION: To the authors' knowledge this is the first report of intradural tumours of the spinal accessory nerves not derived from schwann cells and the first report of bilateral intracranial meningiomatous lesions without dural attachment.- - - - - - - - - - ranking = 6keywords = meningioma (Clic here for more details about this article) |
8/84. Sixth nerve schwannoma: a case report with literature review.A 40-year-old woman presented with diplopia and left VI nerve palsy. After investigations, diagnosis of a meningioma in the parasellar-prepontine region was considered. Following angiography and embolization, near-total excision of the tumour attached to abducens nerve was performed. Histological examination was consistent with the diagnosis of schwannoma. This is the thirteenth case report of a schwannoma of cranial nerve VI and the first such case where embolization of feeding tumour vessels was performed.- - - - - - - - - - ranking = 1keywords = meningioma (Clic here for more details about this article) |
9/84. Bilateral optic nerve sheath meningiomas in a patient with neurofibromatosis type 2.A 34-year-old woman who presented with hearing loss and tinnitus was found to have reduced vision bilaterally. Computed tomography scan revealed bilateral acoustic neuromas and bilateral optic nerve sheath meningiomas. The presence of bilateral acoustic neuromas fulfils the criteria for the diagnosis of central neurofibromatosis (neurofibromatosis type 2). Although this is the first report of bilateral optic nerve sheath meningioma in neurofibromatosis type 2, meningiomas are commoner in this dominantly inherited disorder, than in its absence and both forms of central nervous system tumour may be caused by loss of tumour suppressor genes on chromosome 22.- - - - - - - - - - ranking = 8.3108290799018keywords = meningioma, meningiomas (Clic here for more details about this article) |
10/84. meningioma arising from the trigeminal nerve: a case report and literature review.We report a 69-year-old woman with a meningioma who presented with a 9-month history of progressive facial numbness in the distribution of the left mandibular nerve and left facial palsy. magnetic resonance imaging revealed a mass in and around the left Meckel's cave (MC). The tumor was totally resected through a lateral suboccipital and subtemporal combined approach. It appeared to be a schwannoma, because it adhered firmly to the cisternal portion of the trigeminal nerve without dural attachment. Histopathological examination revealed that it was a meningothelial meningioma. We concluded that the tumor originated from the arachnoid cap cells within the trigeminal nerve sheath, not from the dura mater in the MC.- - - - - - - - - - ranking = 2keywords = meningioma (Clic here for more details about this article) |
| | Next -> |