2023 Volume 32 Issue 10 Pages 666-673
Primary extradural meningioma is a rare disease, accounting for 1 to 2% of all meningiomas. We present a rare case in which primary extradural meningioma led to a giant deformity. An 80-year-old man was admitted to the hospital due to his complaint of left hemiplegia for half a year. During the examination, a painless elastic and soft mass was noted on the parietal region. CT scan showed osteolytic destruction of the parietal bone, and MRI with contrast showed a 15cm×11cm×11cm irregularly enhanced epidural mass and a subdural mass penetrating the dura mater and compressing the right frontoparietal lobe.
Cerebral angiography showed dark staining of bilateral external carotid arteries. The patient was diagnosed with a meningioma and considered to be at high risk of bleeding. We planned a two-stage operation : epidural tumor resection, followed by subdural tumor resection and cranioplasty. Prior to the operation, tumor embolization was performed, and the superficial temporal artery and occipital artery were ligated immediately before the operation. However, after both operation, an epidural hematoma developed, and the patient had to undergo hematoma evacuation. We considered that this was due to hemorrhage from the scalp, which is rich in blood flow, and that the issue is how to prevent it. We report the operational strategy and treatment course of this rare case with a review of literature.
