Extracranial meningioma in the vicinity of the temporal bone: a difficult preoperative diagnosis

Extracranial meningioma is a rare tumor, and most of the time only after histopathologic examination is diagnosis possible.

A 40-year-old right-handed woman presented with progressive swelling over the right side of the forehead and temporal region associated with proptosis and visual loss. Incisional biopsy of the lesion was reported as spindle cell tumor. Computed tomography scan showed large enhancing predominantly extracranial lesion located in the right anterior frontotemporal region extending into the infratemporal fossa and a relatively thin sheet of tumor on the intracranial aspect of the thickened temporal. Intraoperative impression was malignant tumor involving the temporalis muscle, and a near total excision of the lesion was performed. Histopathologic features were suggestive of meningothelial meningioma arising from the temporal bone with predominant extracranial extension.

Preoperative suspicion of a meningioma in this patient would have resulted in a more aggressive surgical approach as these lesions are relatively benign with indolent course.