PMC3740616_01
Pelvis X-rays showing left iliac wing reconstruction with tibial autografts and stabilization with screw-rod type osteosynthesis
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F1
Preoperative plain CT scan (a) and postcontrast CT scan images (b), (c) and (d) showing a rounded, well-defined, heterogeneously hyperdense, and enhancing lesion in the right frontoparietal region, with circumferential edema and mass effect
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F2
The computed tomography (CT) scan showed an extra-axial, dural based, heterogeneously hyperdense, and enhancing lesion in the right frontoparietal parasagittal region, with moderate circumferential edema and mass effect [Figure 2].
Bone window CT scan in sagittal view obtained at the time of admission showing no osteolytic changes of the calvarial bone
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F3
No abnormalities in the skull abutting to the tumor were noted [Figure 3] and imaging features were strongly suggestive of a meningioma.
Preoperative axial (a) and coronal (b) postgadolinium T1-weighted MRI images, showing a strongly enhancing right frontoparietal tumor with sagittal venous sinus invasion. Note the dural tail indicating a meningeal tumor
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F4
T1-weighted MRI scans, hyperintense on T2-weighted MRI scans and displayed important enhancement with gadolinium. The tumor was attached to the dura of the convexity with present dural tail sign and invaded partially the superior sagittal sinus increasing evidence of a meningeal tumor [Figure 4].
Intraoperative photograph of the bone flap showing extradural lobulated tumor tissue tightly attached to the inner calvarial bone
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F5
The patient underwent a right frontoparietal craniotomy with an amazing discovery: The tumor was associated with a small lobulated epidural extension tightly attached to the skull [Figure 5].
Hematoxylin and eosin-stained tumor specimen showing densely packed, small round cells with scanty clear cytoplasm and regular vesicular and hyper chromatic nuclei; magnification, x200
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F6
The tumor was composed of densely packed, small round, dark staining cells with scanty cytoplasm on light microscopy [Figure 6].
Postoperative coronal CT scan showing near total tumor removal with craniotomy defect
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F7
A postoperative CT scan confirmed the extent of tumor resection with a postoperative craniotomy defect [Figure 7].