PMC9622770_01
Preoperative images: (A) axial thin-cut skull CT shows an osteogenic lesion in the right parietal bone. (B) 3D-CT shows crater-like changes in the outer layer of the skull. Axial T2 imaging revealed a hypointense intraosseous lesion and arachnoid granules protruding into the diseased bone [(C), red arrow]. (D) Coronal gadolinium-enhanced MR imaging exhibits mild to moderate homogeneous enhancement with an intense dural reaction. Postoperative CT shows total resection of the tumorized calvaria lesion with good coverage by a titanium mesh (E,F).
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F1
Thin-cut skull computed tomography (CT) showed a large parietal osteogenic calvarial lesion measuring 7.1 x 5.8 x 2.2 cm (Figure 1A). The lesion involved the full layer of the parietal bone with crater-like changes in the outer layer of the skull (Figure 1B). Further T2-weighted magnetic resonance (MR) imaging revealed a hypointense intraosseous lesion (Figure 1C). Gadolinium-enhanced MR imaging presented mild to moderate homogeneous enhancement with an intense dural reaction (Figure 1D). Postoperative CT showed total resection of the tumorous calvaria lesion with complete restoration of the symmetry of the skull (Figures 1E,F).
The extent of the preoperatively planned resection was outlined by the neuronavigation system before surgery.
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F2
Before the operation, the approximate extent of the resection was determined by the neuronavigation system (Figure 2).
Pathology of the primary intraosseous meningioma. (A) The intertrabecular spaces had been infiltrated by meningioma cells (hematoxylin / eosin staining, 100x). (B) The cells had differentiated from meningothelial cells as syncytia (red arrow), with some intranuclear inclusions (yellow arrow) and exhibited a low Ki-67 proliferation rate (C).
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F3
Microscopic examination of H/E-stained sections revealed that the intertrabecular spaces had been infiltrated by tumor cells with eosinophilic cytoplasm and round nuclei, which extended into the subcutaneous space and dura (Figure 3A). The cells were differentiated from meningothelial cells as syncytia, with some intranuclear inclusions (Figure 3B). The Ki-67 labeling index was 5%, indicating a low proliferative potential (Figure 3C).