[Intra-extracranial meningioma in the cranial vault]

Between 1982 and 1993, 11 cases of intra-extracranial vault meningiomas were treated in Créteil, by the same multidisciplinary team. The average age was 53.5 years and the Karnofsky rating was high (> 80 in 7 cases). Ten of the 11 cases had medial tumours with venous sinus thrombosis occurring in 9 of these. The location of the tumour was frontal in 6 and parietal in 4 patients. Of the medial tumours, 5 (half) were bilateral intracranial lesions. The average duration of symptoms was more than 10 years in four cases, between 1 and 3 years in five, and the diagnosis was made immediately in two patients. MRI coronal sections, after venous contrast injection, allowed diagnosis of the lesion and visualisation of the sinus thrombosis. Embolisation was performed pre-operatively in all cases scheduled to have surgery, resulting in safe excision of the tumour. Surgery was performed in 9 patients with complete tumour removal achieved in 8. Of those who did not undergo surgery, one received radiotherapy and the other died before treatment. The bony defect was covered with cadaveric bone, autogenous bone, coral and methyl-methacrylate in one, two, two and two patients respectively. Complications occurred in 2 cases: extradural secondary infection and CSF rhinorrhea treated with a lumbo-peritoneal shunt. The post-operative Karnofsky rating was greater than 90 in seven cases, 70 in one, and 50 in two cases. After an average follow-up of 4 years, 3 patients had tumor recurrence at 4, 7, and 8 years; the first having a locally malignant character, the second showing radiological recurrence in a case of subtotal removal, and the third a marginal recurrence. Two of the 3 patients underwent further surgery. The malignant case, received radiotherapy but unfortunately a new recurrence occurred 14 months later. As radiotherapy was used in only 3 cases, statistically significant conclusions concerning efficacy cannot be drawn.