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LETTER TO EDITOR
Year : 2011  |  Volume : 59  |  Issue : 2  |  Page : 309-310

Bilateral "mirror" cystic meningiomas: A rare radiological presentation


Division of Neurosurgery, Apollo Speciality Hospital, No. 320, Mount Road, Teynampet, Chennai - 600 035, India

Date of Submission23-Dec-2010
Date of Decision23-Dec-2010
Date of Acceptance23-Dec-2010
Date of Web Publication7-Apr-2011

Correspondence Address:
Siddhartha Ghosh
Division of Neurosurgery, Apollo Speciality Hospital, No. 320, Mount Road, Teynampet, Chennai - 600 035
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.79168

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How to cite this article:
Sarkar H, Ghosh S. Bilateral "mirror" cystic meningiomas: A rare radiological presentation. Neurol India 2011;59:309-10

How to cite this URL:
Sarkar H, Ghosh S. Bilateral "mirror" cystic meningiomas: A rare radiological presentation. Neurol India [serial online] 2011 [cited 2021 Mar 2];59:309-10. Available from: https://www.neurologyindia.com/text.asp?2011/59/2/309/79168


Sir,

A 42-year-old male presented with features of raised intracranial pressure of 3 months duration. Contrast magnetic resonance imaging (MRI) of brain showed a dural-based, midline enhancing, plaque-like mass in the anterior one-third parasagittal region with extratumoral cysts on both sides, mirror-image of each other [Figure 1]a-c. Patient underwent bifrontal craniotomy and Simpson's grade 1 excision of the mass. Intraoperatively, a firm, dural-based mass was located in the midline involving the anterior third of the superior sagittal sinus. The extratumoral cyst present on either side contained clear cerebrospinal fluid (CSF) like fluid. These cysts were separate from the ventricular system. The biopsy was reported as meningioma. The cyst wall did not appear to contain neoplastic cells. The patient made a good recovery [Figure 1]d.
Figure 1: (a) MRI brain (Gado) sagittal and (b) axial (plain) sections show anterior one-third parasagittal meningioma with bilateral extratumoral cysts producing "mirror" image (c) of each other; (d) totally removed tumor with resolution of mass effect on the frontal horns

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Cystic meningioma are a rare entity. [1],[2],[3],[4] These tumors occur mostly unilaterally and can be mistaken for glial or metastatic tumors and hemangioblastoma. [1] The tumor in our patient had unique radiological features. This anterior one-third parasagittal meningioma had two extratumoral cysts on either side of the falx, compressing both the frontal horns. The cyst contained clear CSF like fluid. The cyst wall was negative for tumor cells. As per the classification proposed by Nauta and Rengachary, this tumor could be classified as Type III. This is the first ever documented case of bilateral Nauta III cystic meningioma arising from a common dural attachment, presenting with typical imaging features. Several mechanisms have been proposed for cyst formation. In our case, the secretory function of the solid component and the glial reactionary change in the adjacent brain seems to be the most possible mechanism. Evagination of arachnoid by the tumor on both sides of the superior sagittal sinus, that too, at the same location, seems to be a less likely process.

 
  References Top

1.Nauta HJ, Tucker WS, Horsey WJ, Bilbao JM, Gonsalves C. Xanthochromic cysts associated with meningioma. J Neurol Neurosurg Psychiatry 1979;42:529-31.  Back to cited text no. 1
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2.Jung TY, Jung S, Shin SR, Moon KS, Kim IY, Park SJ, et al. Clinical and histopathological analysis of cystic meningiomas. J Clin Neurosci 2005;12:651-5.  Back to cited text no. 2
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3.Souei Mhiri M, Ben Rhouma K, Tlili-Graiess K, El Ouni Salhi C, Jemni Gharbi H, Ben Hnia I, et al. Magnetic resonance imaging features of cystic meningiomas. Report of four cases. J Neuroradiol 2005;32:54-8.  Back to cited text no. 3
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4.Ferrante L, Acqui M, Lunardi P, Qasho R, Fortuna A. MRI in the diagnosis of cystic meningiomas: Surgical implications. Acta Neurochir (Wien) 1997;139:8-11.  Back to cited text no. 4
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