6例跨颅板内外硬膜外脑膜瘤临床及影像学表现
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摘要
目的探讨跨颅板内外硬膜外脑膜瘤(PEM)临床及影像表现,提高对该病的认识。方法回顾性分析经病理证实的6例跨颅板内外PEM临床特点、影像表现并复习国内外文献。结果 6例PEM平均年龄约为60. 8岁,男:女为1:2,临床表现主要为疼痛、头部肿块、眼球突出、视力下降。5例发生于颞骨及眼眶外侧壁,1例发生于额顶骨。影像表现1例颅骨表现为硬化型,2例为溶骨型,3例为混合型,颅板内外软组织肿块CT、MRI表现与硬膜内脑膜瘤影像特点一致。结论跨颅板内外PEM主要以肿块及邻近组织压迫症状就诊,影像上软组织肿块与硬膜内脑膜瘤相似,可出现溶骨、成骨或者混合型骨质破坏,具有一定特征。
Objective To investigate the CT,MRI characteristics and clinical data of primary extradural meningiomas( PEM) extending from dura to extracalvarial space and to improve its knowledge. Methods The clinical data and imaging characteristics of 6 PEM cases performed by surgery and pathology were analyzed retrospectively and the relevant literatures were reviewed. Results The mean age was 60. 8 years. The male-to-female ratio was 1:2. The common presenting symptoms included painless and gradually expanding mass,exopthalmos and impaired vision. 6 cases of tumors which were totally resected( WHO Ⅱ Ⅲ),all lesions were located in the extradural space which extension from the dura to extracalvarial space. 4 cases were involved with dura in different degrees. Among all cases,PEM was located in the temporal bone and orbital lateral-wall in 5 cases,the frontal calvarium in 1 case. The skull of 1 case showed sclerosis,2 cases showed osteolysis,3 cases showed a mixed picture. The CT of 6 cases showed slightly high density with ill-defined margins. MRI suggested low intensity in T1WI signal,and slight increase in T2WI signal,and similar to or slightly high intensity in DWI signal,and enhanced scan suggested homogeneous enhancement. The dural tail sign on enhanced MRI was observed in all 6 cases.Conclusion The reasons for presentation to the hospital of PEM extending from dura to extracalvarial space was painless and gradually expanding mass,exopthalmos and impaired vision. The imaging characteristics of PEM mass had certain specific CT and MRI characteristics,which were similar to primary intradural meningiomas and the destruction of skull including osteolytic or sclerosis or mixed picture was noted.
Objective To investigate the CT,MRI characteristics and clinical data of primary extradural meningiomas( PEM) extending from dura to extracalvarial space and to improve its knowledge. Methods The clinical data and imaging characteristics of 6 PEM cases performed by surgery and pathology were analyzed retrospectively and the relevant literatures were reviewed. Results The mean age was 60. 8 years. The male-to-female ratio was 1:2. The common presenting symptoms included painless and gradually expanding mass,exopthalmos and impaired vision. 6 cases of tumors which were totally resected( WHO Ⅱ Ⅲ),all lesions were located in the extradural space which extension from the dura to extracalvarial space. 4 cases were involved with dura in different degrees. Among all cases,PEM was located in the temporal bone and orbital lateral-wall in 5 cases,the frontal calvarium in 1 case. The skull of 1 case showed sclerosis,2 cases showed osteolysis,3 cases showed a mixed picture. The CT of 6 cases showed slightly high density with ill-defined margins. MRI suggested low intensity in T1WI signal,and slight increase in T2WI signal,and similar to or slightly high intensity in DWI signal,and enhanced scan suggested homogeneous enhancement. The dural tail sign on enhanced MRI was observed in all 6 cases.Conclusion The reasons for presentation to the hospital of PEM extending from dura to extracalvarial space was painless and gradually expanding mass,exopthalmos and impaired vision. The imaging characteristics of PEM mass had certain specific CT and MRI characteristics,which were similar to primary intradural meningiomas and the destruction of skull including osteolytic or sclerosis or mixed picture was noted.
引文
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2 Bassiouni H,Asgari S,Hübschen U,et al. Dural involvement in primary extradural meningiomas of the cranial vault[J]. J Neurosurg,2006,105:51-59.
3 Batoglu-Karaaltin Aysegül,Turgut Fatih Nesrettin,Ylmaz Mehmet et al. Isolated middle ear meningioma.[J]. Kulak Burun Bogaz Ihtis Derg,2016,26:238-240.
4 Bohara Sangita,Agarwal Swapnil,Khurana Nita,et al. Primary intraosseous atypical inflammatory meningioma presenting as a lytic skull lesion:Case report with review of literature.[J]. Indian J Pathol Microbiol,2016,59:386-388.
5 Yamamoto Junkoh,Kurokawa Toru,Miyaoka Ryo et al. Primary intraosseous meningioma in the calvaria:morphological feature changes on magnetic resonance images over several years.[J]. Jpn J Radiol,2015,33:437-440.
6 文新年,黄婷婷,唐纪兰,等.板障型脑膜瘤的影像学表现[J].实用放射学杂志,2013,29:1050-1053.
7 Yun JH,Lee SK. Primary osteolytic intraosseous atypical meningioma with soft tissue and dural invasion:report of a case and review of literatures[J]. J Korean Neurosurg Soc,2014,56:509-512.
8 邢千超,冯平勇,程豪,等.额骨脑膜瘤一例[J].临床放射学杂志,2012,31:1822.
9 梁长虹,陈乃楹,关月欢.颅骨内异位脑膜瘤的影像学诊断[J].中华放射学杂志,1997,31:40-43.
10 Liu Y,Wang H,Shao H,et al. Primary extradural meningiomas in head:a report of 19 cases and review of literature[J]. Int J Clin Exp Pathol,2015,8:5624-5632.
11 刘玉光,张泽立,王宏伟.头部原发性硬膜外脑膜瘤的临床特点[J].中华医学杂志,2014,94:692-694.
12 Mattox A,Hughes B,Oleson J,et al. Treatment recommendations for primary extradural meningiomas[J]. Cancer,2011,117:24-38.
13 Tokgoz N,Oner YA,Kaymaz M,et al. Primary intraosseous meningioma:CT and MRI appearance[J]. AJNR,2005,26:2053-2056.
14 Politi M,Romeike BF,Papanagiotou P,et al. Intraosseous hemangioma of the skull with dural tail sign:radiologic features with pathologic correlation[J]. AJNR,2005,26:2049-2052.
2 Bassiouni H,Asgari S,Hübschen U,et al. Dural involvement in primary extradural meningiomas of the cranial vault[J]. J Neurosurg,2006,105:51-59.
3 Batoglu-Karaaltin Aysegül,Turgut Fatih Nesrettin,Ylmaz Mehmet et al. Isolated middle ear meningioma.[J]. Kulak Burun Bogaz Ihtis Derg,2016,26:238-240.
4 Bohara Sangita,Agarwal Swapnil,Khurana Nita,et al. Primary intraosseous atypical inflammatory meningioma presenting as a lytic skull lesion:Case report with review of literature.[J]. Indian J Pathol Microbiol,2016,59:386-388.
5 Yamamoto Junkoh,Kurokawa Toru,Miyaoka Ryo et al. Primary intraosseous meningioma in the calvaria:morphological feature changes on magnetic resonance images over several years.[J]. Jpn J Radiol,2015,33:437-440.
6 文新年,黄婷婷,唐纪兰,等.板障型脑膜瘤的影像学表现[J].实用放射学杂志,2013,29:1050-1053.
7 Yun JH,Lee SK. Primary osteolytic intraosseous atypical meningioma with soft tissue and dural invasion:report of a case and review of literatures[J]. J Korean Neurosurg Soc,2014,56:509-512.
8 邢千超,冯平勇,程豪,等.额骨脑膜瘤一例[J].临床放射学杂志,2012,31:1822.
9 梁长虹,陈乃楹,关月欢.颅骨内异位脑膜瘤的影像学诊断[J].中华放射学杂志,1997,31:40-43.
10 Liu Y,Wang H,Shao H,et al. Primary extradural meningiomas in head:a report of 19 cases and review of literature[J]. Int J Clin Exp Pathol,2015,8:5624-5632.
11 刘玉光,张泽立,王宏伟.头部原发性硬膜外脑膜瘤的临床特点[J].中华医学杂志,2014,94:692-694.
12 Mattox A,Hughes B,Oleson J,et al. Treatment recommendations for primary extradural meningiomas[J]. Cancer,2011,117:24-38.
13 Tokgoz N,Oner YA,Kaymaz M,et al. Primary intraosseous meningioma:CT and MRI appearance[J]. AJNR,2005,26:2053-2056.
14 Politi M,Romeike BF,Papanagiotou P,et al. Intraosseous hemangioma of the skull with dural tail sign:radiologic features with pathologic correlation[J]. AJNR,2005,26:2049-2052.