Primary intraosseous meningioma of the vertebra: illustrative case

BACKGROUND Primary intraosseous meningiomas (PIMs) are rare, and PIMs of the vertebrae have not yet been reported. The authors report a case of primary meningioma arising from the vertebrae. OBSERVATIONS A 49-year-old man presented with lower back pain and numbness in both lower extremities. Lumbar spine magnetic resonance imaging revealed an L2 pathological fracture with epidural and paraspinal invasion. The patient had undergone a first palliative decompression and fixation surgery, and the diagnosis turned out to be a World Health Organization grade III anaplastic meningioma based on histopathology. The tumor had progressed after first operation and radiation therapy, and the patient was referred to the authors’ institute for excision. The patient had an uneventful postoperative course after a revisional total en bloc spondylectomy of L2. LESSONS The authors present a rare case of PIM of the vertebrae with epidural and paraspinal invasion. Careful preoperative assessment and surgical planning is crucial for successful patient management.

Cranial Meningiomas Requiring Cranioplasty

Aims Bone infiltration in association with intracranial meningioma (4.5% of cases) and primary intraosseous meningioma (2%) are rare. Management can be challenging, as cranial vault reconstruction may be required. This study aimed to examine the surgical techniques used and outcomes in this patient population. Method A single-centre, retrospective cohort study was conducted between January 2010 and September 2020. All adult patients who required cranial reconstruction due to bone involvement of their meningioma were included. Patient demographics, tumour characteristics, operative details, complications, and outcomes were examined. Statistical analyses were performed using SPSS v24.0. Results There were 30 patients (17 female; 56.7%), median age 54 yrs (range 28-86 yrs), of whom 25 (83.3%) had bone infiltration, and 5 (16.7%) had primary intraosseous meningioma. Only 10 patients had a Simpson I or II resection. Twenty-eight had 'on-table' primary cranioplasties. Materials used were titanium (n=13; 43.3%), acrylic (n=10; 33.3%), PMMA (n=5; 16.7%), and hydroxyapatite (n=2; 6.7%). There were 9 (mostly minor) surgical complications and only one wound infection. Twelve patients had WHO grade II tumours, and 14 required radiotherapy. Ten patients (33.3%) had re-operation for recurrent tumour, with a median time to progression of 41 months. At 6 months, 24 patients had a performance score less than 2. Conclusion On-table cranioplasty provides a lower risk surgical option for patients with high risk meningiomas.

Giant Calcified Cavernous Hemangioma Managed with Modified Double Concentric Craniotomy

Giant calcified cavernous hemangioma is uncommon, and calvarial invasion with intracranial extension and dural breach is rare. Radiological resemblance to lesions like meningioma is unreported. Surgical excision of such lesions is technically challenging.A35-year-old female presented with recurrent generalized tonic-clonic seizures for 2 years. Imaging suggested a highly vascular lesion arising from the skull, mimicking intraosseous meningioma, sarcoma, metastases, and so on. Double concentric craniotomy was done with lifting of bones separately around sinuses with radial cuts of dura to visualize tumor-cortical interface to safeguard neurovascular structures, and complete excision was achieved. Histopathology was suggestive of calcified cavernous hemangioma. The patient was asymptomatic at 1 year of follow-up.Differentiating angiomatous and intraosseous meningioma from calcifying giant hemangioma and other mimicking lesions may be difficult on imaging. Modified double concentric craniotomy, although used uncommonly, can be a useful technique safeguarding the neurovascular structures in its proximity.

Primary intraosseous meningioma: a case report

Primary intraosseous meningioma (PIM) is a rare form of meningioma, a benign lesion of the meninges. Imaging evaluation of a patient with frontoparietal scalp swelling revealed an osteoblastic intracalvarial lesion. Following surgical resection, the histological examination revealed an intra-osseous meningioma. Birdem Med J 2021; 11(2): 133-136

68Ga-DOTATOC-PET/CT–guided resection of a primary intraosseous meningioma: technical note

Primary intraosseous meningiomas (PIMs) are rare tumors that present with a variable radiological appearance and a clinical behavior that is considerably different from that of intracranial meningiomas. Treatment of PIMs consists of complete resection, which may be difficult to achieve due to the lack of clear tumor margins on conventional imaging studies. PET/CT using 68Ga-DOTA–conjugated peptides has been used for the diagnosis and treatment planning of different types of meningiomas due to these tracers’ affinity to somatostatin receptors, which are found in most meningiomas. However, this imaging modality’s use as an intraoperative adjunct has not been reported for PIMs. In this technical note, the authors describe a [68Ga-DOTA0-Tyr3]octreotide (68Ga-DOTATOC)-PET/CT–guided resection of a PIM. In this case, the area of increased uptake in the 68Ga-DOTATOC-PET/CT study extended well beyond the tumor margins identified on MRI. The patient’s pathology report confirmed the presence of tumor cells within peripheral bone, which macroscopically appeared normal. The authors propose 68Ga-DOTATOC-PET/CT as a valuable adjunct in the surgical management of PIMs and offer a reasonable justification for its use based on current evidence. Its use for intraoperative image guidance may aid neurosurgeons in achieving a complete resection, thus minimizing the risk of recurrence of this complex pathological entity.