Spheno-orbital meningioma with unusual radiological features

We report a patient with a spheno-orbital meningioma having unusual clinical and radiological features. Eight days before consultation, this 66-year-old female developed right exophthalmos associated with periorbital pain. Neuroradiological features included, (1) multilocular intratumoral cyst on enhanced CT, (2) preferential extradural growth with prominent bony destruction and intratumoral hemorrhage on MRI. and (3) early venous draining on CAG. Histopathology including immunohistochemistry and electron microscopy revealed typical transitional meningioma. The only uncommon pathological feature was that the attachment consisted of the outer (periosteal) layer of the dura, and the microscopic structure of the inner (meningeal) layer was normal.