PMC6580879_01
(A) Disfigurement of forehead across suture lines. (B) Contrast computerized tomography brain scan showing right middle one third parasagittal lesion with hypodense area with overlying hyperostotic bone. (C) Magnetic resonance imaging scan shows contrast enhanced dural-based lesion with underlying hypointense (fat) and overlying hyperostotic calvarium. (D) Intraoperative hyperostotic calvarium.
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Hyperostosis of calvarium was disproportionately larger than the underlying dural-based lesion. He underwent "drilling and remodeling of the frontotemporoparietal hyperostotic bone, right frontoparietal craniotomy, and a Simpson grade-I excision of a right frontoparietal lesion." Histopathology revealed a meningeal neoplasm with hypercellularity, small cell changes, sheathing pattern suggestive of atypical meningioma (World Health Organization [WHO] grade II), along with psammoma bodies, and extensive lipomatous metaplasia (Figure 1).