J Korean Neurosurg Soc.  2016 Nov;59(6):584-589. 10.3340/jkns.2016.59.6.584.

Sclerosing Meningioma : Radiological and Clinical Characteristics of 21 Cases

• Kang H
• Kim JW
• Se YB
• Dho YS
• Choi SH
• Park SH

• KMID: 2417340
• DOI: http://doi.org/10.3340/jkns.2016.59.6.584

Abstract

OBJECTIVE
A rare subtype of meningioma, sclerosing meningioma is not included in the current World Health Organization classification of meningiomas and is classified into the category of other morphological variation subtypes. Sclerosing meningioma is often misdiagnosed to other non-benign meningioma or malignant neoplasm, so it is important to diagnose sclerosing type correctly. We analyzed the radiological and clinical characteristics of a series of sclerosing meningiomas.
METHODS
Twenty-one patients who underwent surgery in one institute with a histopathologically proven sclerosing meningioma were included from 2006 to 2014. Eighteen tumors were diagnosed as a pure sclerosing-type meningioma, and 3 as mixed type. Magnetic resonance image was taken for all patients including contrast enhancement image. Computed tomography (CT) scan was taken for 16 patients. One neuroradiologist and 1 neurosurgeon reviewed all images retrospectively.
RESULTS
In the all 16 patients with preoperative CT images, higher attenuation was observed in the meningioma than in the brain parenchyma, and calcification was observed in 11 (69%). In 15 of the 21 patients (71%), a distinctive very low signal intensity appeared as a dark color in T2-weighted images. Nine of these 15 tumors (60%) exhibited heterogeneous enhancement, and 6 (40%) exhibited homogeneous enhancement that was unlike the homogeneous enhancing pattern shown by conventional meningiomas. Ten patients had a clear tumor margin without peritumoral edema.
CONCLUSION
Although these peculiar radiological characteristics are not unique to sclerosing meningioma, we believe that they are distinctive features that may be helpful for distinguishing sclerosing meningioma from other subtypes.

Keyword

Meningioma; Magnetic resonance imaging

MeSH Terms

Brain
Classification
Edema
Humans
Magnetic Resonance Imaging
Meningioma*
Neurosurgeons
Retrospective Studies
World Health Organization

Figure

• 

  Fig. 1 Illustrative case. A and B : Preoperative MR images revealed 4 cm size round mass in cerebellum which was very low signal intensity on T2-weighted image without peritumoral edema and heterogeneously enhancing lesion after contrast administration. C : Preoperative CT scan showed high attenuated lesion with diffuse and scattered calcification. D : Intraoperative photograph shows entirely avascular nature with yellowish color and clear margin to brain parenchyme. Because the tumor was very tough and hard, the tumor was removed totally by using an electromagnetic field system.

• 

  Fig. 2 T2-wheighted MR images of all patients with sclerosing meningioma except for the illustrative case. Among 21 patients, 15 patients (71%) have their distinctive very low signal intensity which seemed to be nearly dark color on T2-weighted images whereas isodense signal intensity on T2 images was found in only 6 patients. Furthermore, the majority of sclerosing meningioma revealed absent or minimal extent of peritumoral edema. Moderate to severe peritumoral edema found in only 4 patients.

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