A case of intraosseous meningioma with extracranial progression having difficulty in making a preoperative diagnosis

: Intraosseous meningioma is very rare and is often confused preoperatively with a primary bone tumor of the skull. We report a case of intraosseous meningioma with hyperostosis for which preoperative diagnosis was difficult. A 78-year-old female with a slowly growing hard mass in the left parietal bone was admitted. Neurological findings were normal. Plain skull radiograph showed a 6 x 6 cm hyperostotic lesion in the left parietal bone. Bone window CT scan showed thickening and hyperostosis in the same area. MRI using Gd-DTPA showed heterogeneous enhancement of the intraosseous mass, and homogenous enhancement of the dura matter. And angiogram showed a tumor stain fed by the bilateral superficial temporal artery and the It-occipital artery. The tumor and the underlying dura mater were totally removed. Preoperative diagnosis was an osteogenic tumor, but histological examination revealed a transitional meningioma. We discussed the development and the classification of an ectopic meningioma and the mechanism of hyperostosis. We should be aware of the existence of intraosseous menigiomas mimicking osteogenic tumors.