顶枕骨原发性骨内脑膜瘤1例并文献复习OA

Objective To investigate the clinical findings,imaging features,diagnosis,treatment,and prognosis of primary intraosseous meningioma,thereby enhancing recognition of this rare entity.Methods The clinical data of a pathologically confirmed primary intraosseous meningioma patient treated at Xiangyang NO.1 People's Hospital in November 2023 were analyzed retrospectively.The relevant literature were reviewed.Results A 34-year-old female presented with a painless occipitoparietal mass persisting for 2 years.Neurological examination was unremarkable.Physical examination revealed an approximately 8 cm×8 cm area of localized cutaneous protrusion over the occipitoparietal region.The mass was firm,non-tender to palpation,without scalp erythema,ulceration,or fluctuance.Preoperative computed tomography(CT)demonstrated extensive osseous thickening,expansion,and hyperdensity with a ground-glass appearance involving the bilateral posterior parietal and occipital bones.Magnetic resonance imaging(MRI)confirmed extensive bone thickening,expansion,and deformity in the same regions,exhibiting long T1 and short T2 signals.Contrast-enhanced MRI revealed no significant intralesional enhancement but showed enhancement of the adjacent dura mater.Preoperative imaging favored fibrous dysplasia.Given the lesion's proximity to the dural venous sinuses and considering the family's preference,partial resection combined with cranioplasty was performed.Postoperative pathological examination confirmed an extradural primary intraosseous meningioma,meningothelial subtype,World Health Organization(WHO)grade I.Immunohistochemistry was positive for Vimentin,epithelial membrane antigen(EMA),somatostatin receptor 2(SSTR-2),and progesterone receptor(PR),with a Ki-67 proliferation index<2%.Postoperatively,the patient received oral bisphosphonate therapy.Telephone follow-up at 2 years post-surgery indicated no evidence of local recurrence.Conclusions Primary intraosseous meningioma represents a rare clinical entity frequently misdiagnosed as other bony lesions.Definitive diagnosis hinges on postoperative histopathological examination and immunohistochemistry.Complete surgical resection constitutes the primary treatment modality and is generally associated with a favorable prognosis;however,long-term follow-up remains essential.When lesions abut critical venous sinuses,preserving sinus integrity is paramount.In such scenarios,Simpson grade Ⅲ-Ⅳ resection may represent an acceptable surgical strategy to balance tumor removal with vital structure preservation.