- Department of Surgery, Federal Teaching Hospital, Ido Ekiti/Afe Babalola University Ado Ekiti, Nigeria,
- Department of Haematology and Blood Transfusion, Afe Babalola University, Ado Ekiti,
- Department of Medicine, Federal Teaching Hospital, Ido Ekiti,
- Department of Anatomic Pathology, Afe Babalola University, Ado Ekiti, Nigeria.
Abiodun Idowu Okunlola, Department of Surgery, Federal Teaching Hospital, Ido Ekiti/ Afe Babalola University, Ado Ekiti, Nigeria.
DOI:10.25259/SNI_507_2021Copyright: © 2021 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: Abiodun Idowu Okunlola1, Ajayi Adeleke Ibijola2, Olakunle Fatai Babalola1, Cecilia Kehinde Okunlola3, Olagoke Olaseinde Erinomo4. Parasagittal cystic meningioma mimicking hemangioblastoma: A case report. 27-Jul-2021;12:368
How to cite this URL: Abiodun Idowu Okunlola1, Ajayi Adeleke Ibijola2, Olakunle Fatai Babalola1, Cecilia Kehinde Okunlola3, Olagoke Olaseinde Erinomo4. Parasagittal cystic meningioma mimicking hemangioblastoma: A case report. 27-Jul-2021;12:368. Available from: https://surgicalneurologyint.com/surgicalint-articles/parasagittal-cystic-meningioma-mimicking-hemangioblastoma-a-case-report/
Background: Cystic meningioma is a rare variety with similar histological profiles like the solid tumors. It has been documented in both supratentorial and infratentorial compartments presenting radiologically as a large cyst with mural nodule mimicking hemangioblastoma.
Case Description: We managed a middle-aged woman who presented with recurrent seizures and brain MRI revealed left frontal cystic parasagittal tumor with mural nodule. She had left frontal awake craniotomy and gross total tumor excision. Histology confirmed meningothelial meningioma.
Conclusion: Cystic meningioma is rare but should be high in differentials of cystic intracranial tumor with dural based nodules. Awake craniotomy is possible for the excision of parasagittal tumor most especially when it is frontal in location.
Keywords: Awake craniotomy, Cystic meningioma, Hemangioblastoma, Parasagittal tumor
Meningioma is a universal tumor which can occur in any location along the neuroaxis where there are arachnoid cap cells.[
We managed a middle-aged woman who presented with recurrent seizures and brain magnetic resonance imaging (MRI) revealed left frontal cystic parasagittal tumor with mural nodule. She had left frontal awake craniotomy and gross total tumor excision. Histology confirmed meningothelial meningioma.
A 48-year-old woman with 6-months history of complex partial seizures resistant to multiple anticonvulsants associated with headache and right hemibody weakness. There was no family history of seizures disorder. She has no history of chronic medical illness. She was initially managed at a nearby tertiary hospital where there was no resident neurosurgeon but referred to our facility on account of 2-week history of progressively worsening symptoms and altered sensorium.
Examination revealed middle aged woman, she was sleepy but rousable with motor aphasia and localized with left hand. There was right supranuclear fasciolaris and right hemiplegia. The examination of other system was normal.
Clinical diagnosis of adult onset seizures secondary to the left frontal space occupying lesion was made. Brain MRI [
Postoperative clinical course was satisfactory, headache, aphasia, and hemiplegia resolved. Histology [
Meningiomas are usually solid tumors and majorities are benign with good prognosis.[
The index patient presented with recurrent complex partial seizures but developed rapidly progressive right hemiparesis and altered sensorium. This is most likely due to rapid expansion of the cystic component and perilesional edema. The etiology of the cystic meningioma is still controversial; however, cystic degeneration within tumor is unlikely to produce the typical cystic tumor with mural nodule.
Although, it is not a common radiological feature of meningioma, a cystic intracranial tumor with dural based nodule should be considered as meningioma until proven otherwise. The diagnosis of cystic meningioma is based on preoperative imaging with CT and or MRI findings and intraoperative confirmation of a large cyst with dura based vascular mural nodules. The histology of the tumor is gold standard of differentiating the tumor from other cystic tumors most especially hemangioblastoma.[
The management is usually surgical due to mass effect of the tumor cyst which usually require decompression and excision of the relatively small solid component for histological confirmation since the preoperative features on the imaging is usually similar to any other cystic tumor. Conventionally, a parasagittal tumor will require general anesthesia for surgical intervention but we successfully excised this parasagittal tumor through awake craniotomy protocol.[
Cystic meningioma is rare but should be high in differentials of cystic intracranial tumor with dural based nodules. Awake craniotomy is possible for the excision of parasagittal tumor most especially when it is frontal in location.
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