A 51-year-old woman with history of Focal seizures, Progressive spast

 

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Doctor's Information

Name : Morteza
Family : Sanei Taheri
Affiliation :Radiology Department,Shohada Tajrish Hospital,SBMU
Academic Degree : Associate Professor of Radiology
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Sahel Babvey

 

Case Section

Neuroradiology

 

Patient's Information

Gender : Female
Age : 51

 

Clinical Summary

A 51-year-old woman with history of Focal seizures, Progressive spastic weakness in legs Increased intracranial pressure and Diplopia

 

Imaging Findings

Iso- signal large tumoral lesion with intense homogenous enhancement is seen at both parasellar and suprasellar area with extension to prepontine cistern and both optic canals. There is encasement and narrowing of basilar trunk and distal of both internal carotid arteries. Extension to sphenoidal and floor of sella are seen. Also, extension to CP angles and IAC’S is visualized.

 

Differential Diagnosis

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Final Diagnosis

Meningioma, meningothelial type, WHO grade I.

 

Discussion (Related Text)

Meningiomas are a diverse set of tumors arising from the meninges, the membranous layers surrounding the central nervous system.[1] They arise from the arachnoid "cap" cells of the arachnoid villi in the meninges.[2] These tumors are usually benign in nature; however, a small percentage aremalignant.[3] Many meningiomas are asymptomatic, producing no symptoms throughout a person's life, and require no treatment other than periodic observation. Symptomatic meningiomas are typically treated with either radiosurgery or conventional surgery. Historical evidence of meningiomas has been found going back hundreds of years, with some successful surgeries for their removal beginning in the 1800s. History and nomenclature The neoplasms currently referred to as meningiomas were referred to with a wide range of names in older medical literature, depending on the source. Various descriptors included "fungoid tumors", "fungus of the dura mater", "epithelioma", "psammoma", "dural sarcoma", "dural endothelioma", "fibrosarcoma", "angioendothelioma", "arachnoidal fibroboastoma", "endotheliosis of the meninges", "meningeal fibroblastoma", "meningoblastoma", "mestothelioma of the meninges", "sarcoma of the dura", and others. The modern term of "meningioma" was first used by Harvey Cushing (1869–1939) in 1922, to describe a set of tumors that occur throughout the neuraxis (brain and spinal cord), but have various commonalities.[4][5] Charles Oberling then separated these into subtypes based on cell structure, and several other researchers over the years have defined dozens of different subtypes as well. In 1979, the World Health Organization (WHO) classified seven subtypes, upgraded in 2000 to a classification system with nine low-grade variants (grade I tumors) and three variants each of grade II and grade III meningiomas.[5] The most common subtypes are Meningotheliomatous (63%), transitional or mixed-type (19%), fibrous (13%), and psammomatous (2%).[6] The earliest evidence of a probable meningioma is from a skull approximately 365,000 years old, which was found in Germany. Other probable examples have been discovered in other continents around the world, including North and South America, and Africa. The earliest written record of what was probably a meningioma is from the 1600s, when Felix Plater (1536–1614) of the University of Basel performed an autopsy on Sir Caspar Bonecurtius.[7] Surgery for removal of meningiomas was first attempted in the 18th century, with the first successful surgery for removal of a meningioma performed in 1835 by Zanobi Pecchioli, Professor of Surgery at the University of Siena.[8] Other notable meningioma researchers have been William Macewen (1848–1924), and William W. Keen (1837–1932).[7] Medical science has continued to make dramatic improvements in meningioma research and treatment over the last century, both in terms of the surgical techniques for resection (removal) of the tumor, and related improvements in anesthesia, antis

 

References

Cushing H. (1922). "The meningiomas (dural endotheliomas): their source, and favoured seats of origin". Brain (45): 282–316. 2. Buetow MP, Buetow PC, Smirniotopoulos JG (November 1991). "Typical, atypical, and misleading features in meningioma". Radiographics 11 (6): 1087–106. PMID 1749851. Retrieved 2008-12-01. 3. Goldsmith BJ, Wara WM, Wilson CB, Larson DA (February 1994). "Postoperative irradiation for subtotally resected meningiomas. A retrospective analysis of 140 patients treated from 1967 to 1990". J. Neurosurg. 80 (2): 195–201. doi:10.3171/jns.1994.80.2.0195.PMID 8283256. 4. Okonkwo et al. p. 5. 5. Prayson, Richard A. "Pathology of Meningiomas". Meningiomas. pp. 31–41. 6. Park, Bong Jin; Kim, Han Kyu; Sade, Burak; Lee, Joung H. "Epidemiology",Meningiomas, pp. 11–13. 7. Okonkwo et al. pp. 7–8. 8. Mirimanoff. p. 18. 9. DeMonte. Al-Mefty's Meningiomas.

 

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