抄録
A 38-year-old female was admitted, because of a dull headache and a slowly growing, hard, fixed mass in the vertex area. Severe papilledema was noted. Plain roentgenograms of the skull showed thickening of the outer table and diploe at the vertex. Selective external carotid angiography demonstrated enlarging branches of both the superficial temporal artery and middle meningeal artery entering the region of the thickened skull and forming a homogeneous tumor stain. The superior sagittal sinus was obscured beneath the thickened skull. Computerized tomography revealed no intracranial mass lesion. Chest X-ray film showed multiple coin lesions in both the lung fields. During the operation, an intraosseous meningioma was found as well as isolated small intradural tumors. The superior sagittal sinus was grossly collapsed without any tumor masses. These tumors were totally removed (grade 1 removal after Simpson). The postoperative course was uneventful. An open biopsy of one of the lung tumors was performed. The skull, falx and lung tumors were identical in histological appearance and showed typical features of meningotheliomatous meningioma.
Without histologically malignant features, meningioma rarely metastasizes. Only 10 cases of metastatic meningioma without craniotomy were reported in the literature from 1941 to 1983. In the present case the lung metastasis seems most likely hematogenous. The route by which the small falx tumors were seeded is not clear.
