Korean J Radiol.  2008 Jul;9(Suppl):S10-S13. 10.3348/kjr.2008.9.s.s10.

A "Benign" Sphenoid Ridge Meningioma Manifesting as a Subarachnoid Hemorrhage Associated with Tumor Invasion into the Middle Cerebral Artery

• Rim NJ
• Kim HS
• Kim SY

• KMID: 1100095
• DOI: http://doi.org/10.3348/kjr.2008.9.s.s10

Abstract

Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.

Keyword

Brain, hemorrhage; Brain neoplasms; Arteries, middle cerebral

MeSH Terms

Humans
Male
Meningeal Neoplasms/*complications/pathology
Meningioma/*complications/pathology
Middle Aged
Middle Cerebral Artery/*pathology
Neoplasm Invasiveness
Skull Neoplasms/*complications/pathology
*Sphenoid Bone
Subarachnoid Hemorrhage/*etiology

Figure

• 

  Fig. 1 Initial CT scans and angiographies of 53-year-old man that presented with sudden onset of severe headache. A. Noncontrast CT axial scan shows large amount of subarachnoid hemorrhage, especially in left sylvian fissure. B. Contrast-enhanced CT axial scan shows enhancing mass lesion around sphenoid ridge with combined bony destruction. C. Contrast-enhanced CT axial scan shows that mass is in contact with left middle cerebral artery. D. Digital subtraction angiography with selective injection of left internal carotid artery reveals no evidence of aneurysms or arteriovenous malformations. E. Three-dimensional rotational angiography demonstrates mild focal dilatation at proximal M2 portion of left middle cerebral artery. F. Axial T2-weighted MR image demonstrates hyperintense mass adjacent to left middle cerebral artery. G. Enhanced axial T1-weighted MR image demonstrates mass with mild enhancement. H. PET scan shows no definite uptake of mass lesion, suggesting benign or low-grade tumor. I. Intraoperative photomicrograph. Perforation at just distal portion of left middle cerebral artery bifurcation is noted.

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