[Deep sylvian meningioma without dural attachment: a case report]

Area of Science:

• Neurosurgery
• Neuropathology
• Neuroradiology

Background:

• Temporal lobe epilepsy can be caused by various intracranial lesions.
• Meningiomas are tumors arising from the meninges, typically attached to the dura.
• Deep sylvian fissure meningiomas without dural attachment are exceptionally rare.

Observation:

• A 34-year-old female with an 8-year history of temporal lobe epilepsy presented with a 5 cm, multilobular, homogeneous tumor deep in the left sylvian fissure.
• Magnetic resonance imaging (MRI) revealed the lesion's location and characteristics.
• Intraoperative findings confirmed the tumor's deep insular location, lack of dural attachment, and adherence to the middle cerebral artery and its perforators.

Findings:

• Histopathological examination diagnosed the tumor as a transitional meningioma, a subtype without evidence of malignancy.
• The tumor's deep location and absence of dural attachment are key distinguishing features.
• Adherence to critical neurovascular structures posed surgical challenges.

Implications:

• This case contributes to the limited literature on deep sylvian meningiomas without dural attachment.
• Understanding the clinicopathological characteristics is crucial for accurate diagnosis and surgical planning.
• Further research may elucidate the specific etiology and optimal management strategies for such rare meningiomas.