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Parapharyngeal meningioma extending from the intracranial space
1Department of Neurosurgery, Kyoto Prefectural University of Medicine, Japan.
Abstract:
A 50-year old woman with a giant parapharyngeal meningioma extending from the intracranial cavity was admitted to our hospital. The parapharyngeal tumor was biopsied using the transoral approach and a histological section diagnosis suggested meningioma. Thereafter, further examination by magnetic resonance images (MRI) and contrast enhanced CT scans revealed a diffuse meningioma en plaque in the posterior fossa. Invasion extended from the clival dura to the right sigmoid sinus. The extracranial extension of a meningioma is very rare but a few cases have been reported. In almost all of the reported cases, a large intracranial meningioma was simultaneously or previously verified by CT scans. Our case was special in that the intracranial mass was not voluminous but showed en plaque extension, and also because the pathway of the extracranial extension through the jugular foramen was clearly visualized by CT and MRI. Obliteration and invasion of the right sigmoid sinus and the internal jugular vein by tumor were also demonstrated.
Insights
A rare case of parapharyngeal meningioma with extracranial extension through the jugular foramen was diagnosed. This giant tumor invaded the sigmoid sinus and internal jugular vein, highlighting unusual tumor pathways.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Meningiomas are typically intracranial tumors.
- Extracranial extension of meningiomas is uncommon.
- Parapharyngeal meningiomas are exceptionally rare.
Observation:
- A 50-year-old woman presented with a giant parapharyngeal meningioma.
- Transoral biopsy confirmed meningioma histologically.
- MRI and CT scans revealed diffuse meningioma en plaque in the posterior fossa.
Findings:
- The tumor extended from the clival dura to the right sigmoid sinus.
- Unusual extracranial extension via the jugular foramen was visualized by CT and MRI.
- Significant invasion and obliteration of the right sigmoid sinus and internal jugular vein were noted.
Implications:
- This case highlights a rare presentation of meningioma with extensive extracranial invasion.
- Advanced imaging techniques (MRI, CT) are crucial for diagnosing and characterizing such rare tumors.
- Understanding these rare pathways is vital for surgical planning and patient management.