Primary intraosseous meningioma of the vault

Primitive intra-osseous meningioma is a rare benign tumor. We report a case with a temporal localization and antro-attical extension into the petrous bone.     

Primary fibrosarcoma of the skull

The case of a 61-year-old woman with fibrosarcoma of the skull is discussed. Despite surgical treatment and irradiation, she died 23 months after diagnosis. Primary fibrosarcoma of the skull is rare but must be considered in the differentiation of the osteolytic lesions of the skull.     

Primary intraosseous hemangioma of the orbit: CT and MR appearance

An 8-year-old girl had acute onset of blurred vision, proptosis, and lateral and vertical gaze palsies on the right. CT and MR examinations showed an expansile mass involving the greater wing of the right sphenoid bone. Pathologic analysis of the surgical specimen revealed a capillary hemangioma. The lesion was inhomogeneous but predominantly isointense with gray matter on T1-weighted images. On T2-weighted images the lesion was inhomogeneous with areas of both high and low signal intensity. The rim enhanced uniformly, and there was inhomogeneous enhancement of the bulk of the lesion.     

Variants in the growth of meningiomas of the base of the skull spreading into the orbit and paranasal sinuses]

PURPOSE: To determine differences in temperature for very low birth weight (VLBW) infants when swaddled and unswaddled in heated, double-walled incubators. DESIGN: A crossover design was used with infants receiving both the swaddled and unswaddled conditions. SAMPLE: 15 very low birth weight infants (< 1,500 gms) with postconceptional ages of 29.1 +/- 1.5 weeks. MAIN OUTCOME VARIABLE: Infant temperature in swaddled and unswaddled conditions. RESULTS: Abdominal temperatures during swaddling were 0.2 degree C higher than the unswaddled condition. In the swaddled condition, infants required a lower incubator temperature (mean = 26.9 +/- 0.4) than when unswaddled (mean = 29.8 +/- 0.5).     

Primary meningioma intimately related to skull: case report and review of the literature

A report is made of a primary meningioma intimately associated with the left sphenoid ridge and temporal bone of a 41-year-old woman. The lesion produced hyperostosis of the involved bones, ipsilateral proptosis, and reduced vision for 4.5 years. The radiotherapy yielded little improvement of the exophthalmos and vision. Review of 125 reported meningiomas intimately related to the skull and presenting primarily with hyperostosis and minimal soft tissue component, including the current case, disclosed that all but one affected the cranium proper, particularly the middle ear, temporal bone, frontal bone, and parietal bone. The exceptional one was in the mandible. They tended to occur between the fifth and seventh decades of life with the peak occurrence between the fifth and sixth decades. The average age was 46 years for overall. The female-to-male ratio was 2:1. Six of 125 primary meningiomas closely associated with the skull were malignant and two of these spread to the lungs. The pulmonary metastasis was spontaneous in one case.     

Bilateral lunate intraosseous ganglia

An intraosseous ganglion is a relatively uncommon, benign, cyst-like lesion that occurs in young and middle-aged adults. Most commonly seen adjacent to the hip, ankle, knee, or wrist, they are histologically identical to their soft tissue counterparts. A review of the literature revealed only two previously reported examples of bilateral symmetrical ganglia of the lunate bones.     

Hypodense meningiomas

While majority of the meningiomas can be diagnosed on contrast enhanced computerised tomography (CT) scans, few of them can have atypical appearances, which may be difficult to distinguish from those seen in glial tumours. Six atypical cases of meningioma having hypodense appearances on CT scan are described.     

Tuberculosis of the skull

Because tuberculosis of the skull is relatively unusual occurrence, it may not be immediately recognized. It responds readily to chemotherapy and should be suspected in disseminated tuberculosis or in any draining lesion of the skull that is sterile or fails to respond to conventional antibiotic therapy.     

Solitary intraosseous infantile myofibroma of the orbital roof

BACKGROUND: There are several rare tumors that can cause proptosis in an infant, including infantile myofibroma. METHODS: A 3-month-old infant developed a painless, bone-destructive superomedial orbital mass, raising concern for orbital malignant neoplasms. Computed tomography disclosed a bone-destructive mass of the sphenoid wing. On magnetic resonance imaging, the intraosseous mass was well-circumscribed, surrounded by cortical bone, and showed prominent enhancement. RESULTS: Superomedial orbitotomy and biopsy revealed a lesion composed of spindled to stellate cells, without mitotic activity, set in a fibromyxoid stroma. Immunohistochemical stains were positive for vimentin and actin. Ultrastructurally, there were actinlike thin filaments, mitochondria, and rough endoplasmic reticulum confirming a myofibroblastic proliferation and supporting the diagnosis of congenital infantile myofibroma. CONCLUSION: Infantile myofibroma is a benign tumor that occurs rarely in the ocular region but can cause prominent bone destruction, misleading the clinician to suspect a malignant neoplasm.     

Radiation-induced intracranial meningiomas

Based on the analysis of 112 cases a clinical characterization has been done of intracranial meningiomas developed secondary to X-ray irradiation of the head for fungus disease of skull integuments. X-ray irradiation increases the risk of intracranial meningioma development up to 4-fold. Radiation-induced intracranial meningiomas are characterized by particular features of clinical manifestations, by preponderance of hyperdense forms, by being of large size, as well as by a high frequency of changes in the adjacent bone presenting as hyperostosis, usuration, and destruction. The above meningiomas are notable for a high specific weight of anaplastic varieties.     

Clinical study on the recurrence of meningiomas: correlating factors for the recurrence and therapeutic prognosis of meningiomas

The sequelae of arthritis of the hip in neonatal period have been analyzed in a series of 75 hips in 68 patients aged from 2 months to 14 years. The diagnosis was set on the basis of history, medical documentation, clinical and radiological examination with standard radiographs, arthrography and sonography included; sometimes as late as at surgery. In 15 joints with synovial type of septic arthritis pathological dislocation has been found. In 60 hips the inflammatory process involved proximal end of the femur. The sequelae strictly depended on localization of the pathology. On the basis of ossification disturbances, deformities and defects found within the head and neck on radiographs in 35 per cent of cases damaged epiphysis, physis and metaphysis were detected. In 23 per cent the neck was involved; in 42 per cent extensive damage to the head and neck was noted.     

Clonal analysis of meningiomas

Meningiomas are primary brain tumors arising from meningothelial cells. They usually grow slowly and are surgically easy to separate from the brain. A recent clonal analysis of meningiomas, using methylation-sensitive restriction fragment length polymorphisms, suggested a monoclonal origin. Using the same technique but with a highly informative X chromosome probe (M27 beta), we found that 17 (85%) of the 20 meningiomas analyzed were informative. Of the 17 informative tumors, 8 (47%) were monoclonal, 3 (18%) had loss of heterozygosity on the X chromosome, and, unexpectedly, 6 (35%) had a polyclonal pattern. Samples from two areas of one tumor showed a monoclonal pattern and loss of heterozygosity, respectively, on the X chromosome. A review of the histopathological and radiological features of the 17 informative tumors did not help to distinguish the clonal from the polyclonal tumors. We conclude that meningiomas are heterogeneous in clonal composition.     

Radiosurgical management of meningiomas

The management of residual, recurrent, or small skull base meningiomas is controversial. Stereotactic radiosurgery has emerged as an alternative treatment. We report our experience from September 1991 to August 1994 of treatment of 20 such patients [18 females -age 19-82 years, followed for 6-36 months (mean 15.5 months)] with the Leksell Gamma Knife. Nine patients were treated either with recurrent (2 patients-2 operations each) or residual tumor. Twelve patients had skull base, 3 optic nerve, 3 parasagittal, and 1 residual torcular tumor. Mean volume/diameter was 9.172 mm3/25 mm.     

Surgery of the base of the skull

To treat pathological processes, primarily tumors, in the base of the skull is one of the most intricate neurosurgical problems. In the past decade, interest in this problem has greatly increased due to the advent of new methods of diagnosis, up-to-date neurosurgical equipment and to a greater cooperation of physicians of related disciplines: ophthalmologists, otosurgeons, plastic surgeons. The authors present and summarize the experience accumulated by the researchers of the N. N. Burdenko Institute of Neurosurgery in the past 10 years in treating basal tumors. Based on a great deal of clinical findings, approaches are proposed in treating some groups of basal tumors, such and pituitary adenomas, craniopharyngiomas, meningiomas at various sites, trigeminal and acoustic neurinomas, and malignant neoplasms of the base of the skull. The conditions required for successful surgical treatment of the processes in the base of the skull are described in detail. One of them is a correct determination of a surgical approach.     

Expression of the bcl-2 oncoprotein in meningiomas

The purpose of this study was to assess the expression of the bcl-2 oncoprotein in meningiomas and to compare it with the phenotype, the Ki-67 proliferative index and the sex hormone receptor status of the tumors. The expression of the bcl-2 oncoprotein was studied by Western blotting and immunohistochemistry. A quantitative study of the Ki-67 proliferative index and the expression of estrogen and progesterone receptors was performed. Western blot detected the bcl-2 oncoprotein in nearly all meningiomas. Immunohistochemistry detected the oncogene in only 43.5% of the cases. Expression of bcl-2 was essentially by spindle cells of transitional and fibrous meningiomas expressing neural cell adhesion molecule. There was neither correlation between the expression of bcl-2 and Ki-67 proliferative index of meningiomas nor statistical concordance between the expression of bcl-2 oncoprotein by meningiomas and their sex hormone receptor protein status. Inhibition of apoptosis could be involved in the growth of meningiomas with a mesenchymal differentiation.     

Mental disorders in meningiomas of the olfactory fossa

In 19 patients with meningiomas of the olfactory fossa the author established a certain development of the psychopathological symptomatology. First of all asthenia ensues, eventually a complacent mood with an underestimation of the severity of the disease and an emotional crudeness is seen. These disorders are gradually substituted by euphoric dementia with a tendency towards foolish jokes, anosognosia of the disease, severe intellectual disorders and a desintegration of the "personality nuclei" with desinhibited drives. The intellectual disorders are expressed not in formal disturbances (logic operations), but in insufficient goal-directness and uncritical thinking.