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A "benign" sphenoid ridge meningioma manifesting as a subarachnoid hemorrhage associated with tumor invasion into the middle cerebral artery.

Rim NJ, Kim HS, Kim SY - Korean J Radiol (2008)

Bottom Line: Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare.To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported.We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea.

ABSTRACT
Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

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Related in: MedlinePlus

Initial CT scans and angiographies of 53-year-old man that presented with sudden onset of severe headache.A. Noncontrast CT axial scan shows large amount of subarachnoid hemorrhage, especially in left sylvian fissure.B. Contrast-enhanced CT axial scan shows enhancing mass lesion around sphenoid ridge with combined bony destruction.C. Contrast-enhanced CT axial scan shows that mass is in contact with left middle cerebral artery.D. Digital subtraction angiography with selective injection of left internal carotid artery reveals no evidence of aneurysms or arteriovenous malformations.E. Three-dimensional rotational angiography demonstrates mild focal dilatation at proximal M2 portion of left middle cerebral artery.F. Axial T2-weighted MR image demonstrates hyperintense mass adjacent to left middle cerebral artery.G. Enhanced axial T1-weighted MR image demonstrates mass with mild enhancement.H. PET scan shows no definite uptake of mass lesion, suggesting benign or low-grade tumor.I. Intraoperative photomicrograph. Perforation at just distal portion of left middle cerebral artery bifurcation is noted.
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Figure 1: Initial CT scans and angiographies of 53-year-old man that presented with sudden onset of severe headache.A. Noncontrast CT axial scan shows large amount of subarachnoid hemorrhage, especially in left sylvian fissure.B. Contrast-enhanced CT axial scan shows enhancing mass lesion around sphenoid ridge with combined bony destruction.C. Contrast-enhanced CT axial scan shows that mass is in contact with left middle cerebral artery.D. Digital subtraction angiography with selective injection of left internal carotid artery reveals no evidence of aneurysms or arteriovenous malformations.E. Three-dimensional rotational angiography demonstrates mild focal dilatation at proximal M2 portion of left middle cerebral artery.F. Axial T2-weighted MR image demonstrates hyperintense mass adjacent to left middle cerebral artery.G. Enhanced axial T1-weighted MR image demonstrates mass with mild enhancement.H. PET scan shows no definite uptake of mass lesion, suggesting benign or low-grade tumor.I. Intraoperative photomicrograph. Perforation at just distal portion of left middle cerebral artery bifurcation is noted.

Mentions: A noncontrast CT scan of the head revealed a large amount of SAH in the basal cisterns and left sylvian cistern (Fig. 1A) with a small amount of subdural hemorrhage in the left frontal convexity. On the CT scan, there was also a small hyperdense mass-like lesion seen in the left sphenoid ridge, which showed bony destruction of the left sphenoid ridge with extension into the left anterior middle cranial fossa (Fig. 1B) and the sphenoid paranasal sinus. This lesion showed mild enhancement and was suspected to be in contact with the left MCA as seen on a contrast-enhanced CT scan (Fig. 1C). The possibility of an SAH originating from the ruptured aneurysm was suggested; therefore, cerebral digital subtraction angiography was performed. Cerebral angiography showed no evidence of aneurysms or arteriovenous malformations, but demonstrated a mild focal dilatation at the proximal M2 portion of the left MCA (Figs. 1D, E) and a small tumor blush from the left middle meningeal artery. Since the possibility of an aneurysm was eliminated, an SAH originating from the malignant tumor with vascular invasion was suspected. MR imaging revealed an extraaxial mass lesion in the left sphenoid greater wing with slightly high signal intensity on T2-weighted images and enhancement on contrast-enhanced T1-weighted images (Figs. 1F, G). This lesion showed no definite uptake on a PET scan, suggesting a benign or low-grade tumor (Fig. 1H).


A "benign" sphenoid ridge meningioma manifesting as a subarachnoid hemorrhage associated with tumor invasion into the middle cerebral artery.

Rim NJ, Kim HS, Kim SY - Korean J Radiol (2008)

Initial CT scans and angiographies of 53-year-old man that presented with sudden onset of severe headache.A. Noncontrast CT axial scan shows large amount of subarachnoid hemorrhage, especially in left sylvian fissure.B. Contrast-enhanced CT axial scan shows enhancing mass lesion around sphenoid ridge with combined bony destruction.C. Contrast-enhanced CT axial scan shows that mass is in contact with left middle cerebral artery.D. Digital subtraction angiography with selective injection of left internal carotid artery reveals no evidence of aneurysms or arteriovenous malformations.E. Three-dimensional rotational angiography demonstrates mild focal dilatation at proximal M2 portion of left middle cerebral artery.F. Axial T2-weighted MR image demonstrates hyperintense mass adjacent to left middle cerebral artery.G. Enhanced axial T1-weighted MR image demonstrates mass with mild enhancement.H. PET scan shows no definite uptake of mass lesion, suggesting benign or low-grade tumor.I. Intraoperative photomicrograph. Perforation at just distal portion of left middle cerebral artery bifurcation is noted.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2627185&req=5

Figure 1: Initial CT scans and angiographies of 53-year-old man that presented with sudden onset of severe headache.A. Noncontrast CT axial scan shows large amount of subarachnoid hemorrhage, especially in left sylvian fissure.B. Contrast-enhanced CT axial scan shows enhancing mass lesion around sphenoid ridge with combined bony destruction.C. Contrast-enhanced CT axial scan shows that mass is in contact with left middle cerebral artery.D. Digital subtraction angiography with selective injection of left internal carotid artery reveals no evidence of aneurysms or arteriovenous malformations.E. Three-dimensional rotational angiography demonstrates mild focal dilatation at proximal M2 portion of left middle cerebral artery.F. Axial T2-weighted MR image demonstrates hyperintense mass adjacent to left middle cerebral artery.G. Enhanced axial T1-weighted MR image demonstrates mass with mild enhancement.H. PET scan shows no definite uptake of mass lesion, suggesting benign or low-grade tumor.I. Intraoperative photomicrograph. Perforation at just distal portion of left middle cerebral artery bifurcation is noted.
Mentions: A noncontrast CT scan of the head revealed a large amount of SAH in the basal cisterns and left sylvian cistern (Fig. 1A) with a small amount of subdural hemorrhage in the left frontal convexity. On the CT scan, there was also a small hyperdense mass-like lesion seen in the left sphenoid ridge, which showed bony destruction of the left sphenoid ridge with extension into the left anterior middle cranial fossa (Fig. 1B) and the sphenoid paranasal sinus. This lesion showed mild enhancement and was suspected to be in contact with the left MCA as seen on a contrast-enhanced CT scan (Fig. 1C). The possibility of an SAH originating from the ruptured aneurysm was suggested; therefore, cerebral digital subtraction angiography was performed. Cerebral angiography showed no evidence of aneurysms or arteriovenous malformations, but demonstrated a mild focal dilatation at the proximal M2 portion of the left MCA (Figs. 1D, E) and a small tumor blush from the left middle meningeal artery. Since the possibility of an aneurysm was eliminated, an SAH originating from the malignant tumor with vascular invasion was suspected. MR imaging revealed an extraaxial mass lesion in the left sphenoid greater wing with slightly high signal intensity on T2-weighted images and enhancement on contrast-enhanced T1-weighted images (Figs. 1F, G). This lesion showed no definite uptake on a PET scan, suggesting a benign or low-grade tumor (Fig. 1H).

Bottom Line: Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare.To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported.We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

View Article: PubMed Central - PubMed

Affiliation: Department of Diagnostic Radiology, Ajou University School of Medicine, Gyeonggi-do, Korea.

ABSTRACT
Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

Show MeSH
Related in: MedlinePlus