Al-Azhar Neurosurgery

E-mail

info@alazharneurosurgery.com

Address

Al-Hussein university hospital , Al-Sayyed Galal hospital

+2 0102 9252247, +2 0111 1726597

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Case 3

Case 3 Convexity meningioma

A close-up of a brain scan Description automatically generated
A close-up of a brain scan Description automatically generated
A close-up of a brain Description automatically generated

Figure 3.1: MRI of the patient:: Coronal sagittal and axial with contrast

Clinical presentation

  • Male patient 77 years old.
  • The condition began one year ago with recurrent attacks of mild, diffuse, dull aching headaches that worsened over the last two months, accompanied by a history of fainting attacks.
  • Two weeks ago, the patient developed an attack of generalized tonic-clonic (GTC) fits lasting about 15 minutes, followed by a postictal state.
  • Examination seems to be normal
  • Q1: Why do meningiomas enhance vividly?
  • This is due to its vascularity and the histological features of its cells, which readily accept contrast. However, the most significant factor is its location outside the blood-brain barrier, as the blood-brain barrier typically rejects contrast material, while in the dura, there is no blood-brain barrier.
  • Q2: How can you differentiate between falcine, parasagittal, and convexity meningiomas when they are in close proximity to the midline?
  • This can be done by following the brain mantle in close proximity to the midline. There will be a rim of brain between the parasagittal and convexity meningioma in the coronal plane, and a rim of brain between the falx and parasagittal sinus in the coronal plane. However, sometimes differentiation is only possible intraoperatively. It is worth mentioning that MRV (Magnetic Resonance Venography) may be valuable in assessing differentiation when it shows obliteration of the superior sagittal sinus.
A close-up of a brain scan Description automatically generated

Figure 3.2: differentiation of meningioma in relation to the sinus.

  • Q3: What is the most common microscopic histological feature of meningioma? How can this affect your surgery?
  • The most common types are the meningothelial, fibroblastic, and transitional, which share features of both. This can affect the surgery by influencing the consistency of the tumor, which may require the use of CUSA (Cavitron Ultrasonic Surgical Aspirator) or a tissue deprider, or the need for a silk suture technique in the case of a fibroblastic convexity type meningioma.