Multimedia
 | Media file 1: Brain meningioma. Posterior tentorial meningioma on a coronal contrast-enhanced CT scan. A hyperattenuating and well-marginated mass is adjacent to the tentorium. Pooling of cerebrospinal fluid (arrows), subtle edema, homogeneous enhancement, and ventricular dilation are demonstrated. |
 | Media file 2: Brain meningioma. Nonenhanced CT scan shows a malignant meningioma in the frontal convexity that appears as a spontaneously hyperattenuating mass. Cystic cavity may be tumor necrosis, old hemorrhage, cystic degeneration, or trapped cerebrospinal fluid. Edema and midline shift to the left anterior aspect is observed. |
 | Media file 3: Brain meningioma. Nonenhanced CT scan shows a malignant meningioma in the frontal convexity (in the same patient as in Image 2). The hyperattenuating and inhomogeneous enhancing mass and a ring-shaped enhancement is shown. |
 | Media file 4: Brain meningioma. Malignant frontal-convexity meningioma. CT scan of the frontal internal table and diploe shows erosion and bone infiltration (same patient as in Images 2-3). |
 | Media file 5: Brain meningioma. Nonenhanced CT scans shows an isoattenuating sphenoid-wing meningioma. The left sylvian fissure is partially collapsed. |
 | Media file 6: Brain meningioma. CT scan shows an isoattenuating sphenoid-wing meningioma. The contrast-enhancing mass is attached to the major sphenoid wing and was demonstrated only after the intravenous injection of contrast material (same patient as in Image 5). |
 | Media file 7: Brain meningioma. Parietal-convexity meningioma. Contrast-enhanced CT scan shows a round, hyperattenuating, and unilobulated mass. Broad-based attachment to the dura is demonstrated, as is intense edema in the subjacent brain. |
 | Media file 8: Brain meningioma. Parietal-convexity meningioma (same patient as in Image 7). Selective injection of the left middle meningeal artery shows inhomogeneous enhancing tumor. Intense vascularity is appreciated on the posterior aspect of the mass. Drainage veins are not seen. |
 | Media file 9: Brain meningioma. Nonenhanced T1-weighted sagittal MRI demonstrates a typical parasagittal meningioma. A homogeneous, long-T1, round mass with thin capsule (arrow) is present. The tumor is attached to the left sagittal dura. Mass effect is noted against the ventricular trigone. |
 | Media file 10: Brain meningioma. Nonenhanced axial MRI demonstrates a typical parasagittal meningioma (same patient as in Image 9). T1-weighted image shows a homogeneous, long-T1, round mass with thin capsule. The tumor is attached to the left side of the falx. Mass effect is noted on the adjacent gyri. |
 | Media file 11: Brain meningioma. Coronal T2-weighted MRI demonstrates a typical parasagittal meningioma. Isointense and inhomogeneous tumor without peripheral edema indicates a more fibrous and harder character, ie, a fibroblastic meningioma (same patient as in Images 9-10). |
 | Media file 12: Brain meningioma. Contrast-enhanced T1-weighted axial MRI demonstrates a typical parasagittal meningioma demonstrated. A homogeneous, enhancing, globose mass is depicted (same patient as in Images 9-11). |
 | Media file 13: Brain meningioma. Contrast-enhanced T1-weighted coronal MRI shows a typical parasagittal meningioma. A homogeneous, enhancing, globose mass is depicted (same patient as in Images 9-12). |
 | Media file 14: Brain meningioma. Parasellar meningioma. Lateral projection from internal carotid angiography shows multiple opacified tumoral vessels in a radial distribution. Circumferential narrowing of the supraclinoid carotid portion is depicted. |
 | Media file 15: Brain meningioma. Nonenhanced CT scans demonstrates a middle fossa meningioma. The calcified mass is attached to the anterior ridge of the right petrous bone. Ring and punctate calcification are depicted. Edema is not appreciated. |
 | Media file 16: Brain meningioma. Middle fossa meningioma. Contrast-enhanced CT scan depicts a round, inhomogeneous, attenuating, enhancing mass (same patient as in Image 15). |
 | Media file 17: Brain meningioma. Middle fossa meningioma. Contrast-enhanced CT scan depicts a dense, enhancing mass (same patient as in Images 15-16). |
 | Media file 18: Brain meningioma. Middle fossa meningioma. Internal carotid artery demonstrates considerable supply from petrous branch. The external carotid artery provided the main blood supply to the tumor (same patient as in Images 15-17). |
 | Media file 19: Brain meningioma. Cerebellopontine angle meningioma. Off-midline sagittal nonenhanced T1-weighted MRI displays a hypointense and inhomogeneous round mass in the cerebellopontine angle. |
 | Media file 20: Brain meningioma. Cerebellopontine angle meningioma. T2-weighted MRI shows a hyperintense mass attached to the petrous bone. Sharply defined tumor margin, subtle edema, and mass effect on the fourth ventricle and the brainstem (same patient as in Image 19) are present. Hyperintensity on T2-weighted image indicates a soft tumor consistency and microhypervascularity, which is seen more often in aggressive, angioblastic, or meningothelial meningioma. |
 | Media file 21: Brain meningioma. Cerebellopontine angle meningioma. Selective angiogram of right occipital artery shows focal hypervascularity through the auricular artery. Early and delayed staining is seen (same patient as in Images 19-20). |
 | Media file 22: Brain meningioma. Cerebellopontine angle meningioma. Right occipital artery embolized with polyvinyl alcohol particles before surgery (same patient as in Images 19-21). |
 | Media file 23: Two different cases. A, B. CT scans depict calcified meningiomas from the parietal convexity. C, D. Nonenhanced axial CT image shows homogeneous calcified mass attached to the right parietal bone. Soft tissue tumor is seen at the posterior aspect of the calcification, -large arrow-. Other minor calcifications on the left cerebral hemisphere are caused by a parasitic disease. Coronal T2 weighted MRI demonstrates calcium deposit -star- surrounded of solid tissue -arrow-, edema is not seen on this case. |
 | Media file 24: Parasagittal meningioma. A. Nonenhanced Sagittal T1 weighted shows a solid dural isointense mass with bone invasion and compression against the parietal cortex. B. Contrast enhanced sagittal T1 weighted demonstrates partially intense enhancement of the tumor. C. Coronal T2 Weighted image shows isointense mass meaning hard tissue. This finding is observed on fibroblastic meningiomas. D. Contrast-enhanced T1-weighted axial MRI shows hyperintense image located within the bony marrow. |
 | Media file 25: (Same patient as in Images 23). A. Noncontrast angio-MRI on lateral view demonstrates occluded superior sagittal sinus due to meningioma invasion. B. MRI reconstruction shows sagittal venous obstruction and 3D appearance of the tumor. |
 | Media file 26: Multiple meningiomas: A. Sagittal T1 weighted demonstrates posterior fossa and parietal meningiomas. B Gadolinium enhancing on Sagittal T1 weighted shows intense enhancing of the masses. C. T2 coronal shows stable hypointense appearance of the posterior mass after endovascular embolization. |
 | Media file 27: Malignant and multiple meningiomas. White man, 47y/o underwent to Gamma Knife due to left convexity meningioma followed of microsurgical removal of the tumor in 2001. A, B. Four years later -December 2005- MRI showed stable residual parietal/occipital mass. Left sigmoid sinus is occluded. C, D. One small right frontal meningioma was also undergone to radiosurgery at the same time. Edema and intense enhancing after gadolinium injection is demonstrated. |
 | Media file 28: A-D. (Same patient as in Images 27) Eight months later -August 2006- Coronal T2 weighted image and enhanced T1 MR Images demonstrated quick growth of convexity mass toward the tentorium and the petrous bone. This bone structure is filled with liquid in its inferior aspect. Surgical biopsy reported "atypical meningioma" |
 | Media file 29: (Same patient as in Images 27). Coronal CT, the bone window shows petrous bone destruction and partial lack of bone plane after surgical removal of the tumor |
 | Media file 30: DSA. (Same patient as in Images 27, August 2006). A, B. Left external carotid artery shows early and delayed stain of the mass through media meningeal, superficial temporal arteries, and C. Occipital artery. D. Those branches were embolized before the surgical procedure. The tumor was partially removed due to cranial base involvement. |
 | Media file 31: Frontal meningioma. (Same patient as in Images 27). A.B. Slow growth and surrounding edema was seen on MRI control of this tumor. Coronal enhanced T1 weighted and FLAIR sequences are showed. C.D. Digital Angiography. Right media meningeal branch demonstrates feeding of the tumor. It was not embolized. |
 | Media file 32: . (Same patient as in Images 27. September 2006). A. 3D Enhanced T1 weighted MR Image shows residual meningioma at the cranial base after second surgical removal. B. Coronal T2 weighted MR Image shows intense edema surrounding the frontal mass. C. 3D image on enhanced T1 MR Image demonstrates frontal meningioma underlying to the orbital right sulcus. D. Gadolinium Axial T1 weighted image shows one of the three focal hyperintense masses discovered only on this sequence. Brain metastases from meningioma have not been proved. |
 | Media file 33: Histopathological report describes as a meningotelial like neoplasm proliferation that shows hypercellularity, prominent nucleolus, regions of necrosis, occluded veins and arteries, dense chromatin, nucleus-cytoplasm relation is altered, 5 or more mitosis by 10 high magnify fields. The neoformation reaches adjacent bone structures. Histopathological diagnosis: left temporal mass compatible with an atypical meningioma meningotelial neoplasm. |
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Further Reading
Keywords
meningothelioma, leptomeningioma, mesothelioma of the dura mater
