Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain / Other / Tumor Case

Meningioma Resection with Cranioplasty

50 yr-old woman with meningioma causing seizure

Description

50 yr-old woman presented to ER with several episodes transient left-sided sensory change and twitching
Symptoms consistent with seizure activity
No significant medical history
Neurological exam unremarkable

Educational Notes

Patient with postop infection required craniectomy and then cranioplasty

Gallery

Images

Figure 1Left: CT performed 6 years prior to presentation (axial upper, coronal lower). Unremarkable findings. Right: CT head performed for seizure (axial upper, coronal lower). Shows new mass in the right posterior frontal region.
Figure 2Initial MRI brain. Images show extra-axial, enhancing, dural–based lesion over the posterior right frontal lobe. There is minimal brain edema.
Figure 3Intraoperative photograph demonstrating patient positioning and OR equipment. Incision is marked out above the right ear.
Figure 4Screenshot captured from intraoperative navigation showing 3D localization of the tumor used to determine where to make incision and where to make craniotomy to access the tumor.
Figure 5Intraoperative photo showing skin incision and surface of the skull.
Figure 6Intraoperative photo after the craniotomy has been made showing the dura mater.
Figure 7Intraoperative photo captured from the surgical microscope showing the tumor on the left and its interface with the brain on the right including a large vein.
Figure 8Immediate postoperative CT showing the area of the surgery and no evidence of postoperative complication.
Figure 9Photo micrograph showing high power microscopic view of the tumor. Cells are arranged in whirls. Pathologic diagnosis is benign (WHO grade 1) meningioma.
Figure 10CT 3 weeks postop shows unremarkable fluid collection underneath the scalp, and outside the skull.
Figure 11MRI 3 weeks postop showing unremarkable fluid conduction underneath the scalp at the site of the surgery. Results of this MRI led another surgical team to aspirate the fluid. Analysis of the fluid revealed no sign of infection.
Figure 12MRI performed approximately 5 weeks postop now showing enhancement within the fluid collection consistent with infection.
Figure 13Intraoperative photograph approximately 5 weeks after initial operation. Incision has been reopened and the bone flap has been removed revealing a layer of infected material which was subsequently removed. Due to the infection, the bone flap could not be replaced.
Figure 14CT performed immediately after craniectomy for infection showing removal of bone flap and cranial defect.
Figure 152D and 3D reconstruction of post–craniectomy surgery showing cranial defect.
Figure 16MRI 3 months postop showing resolution of infection.
Figure 17Computer-generated image showing planning of custom cranial implant to replace the patient's own skull and perfectly fill the cranial defect
Figure 18Intraoperative photo 4 months after initial surgery. Incision has again been reopened and the edges of the craniectomy defect have been exposed. Note the underlying tumor resection area.
Figure 19Intraoperative photo showing custom made cranial implant perfectly fitting into the cranial defect; it is secured with typical cranial mini-plates and screws.
Figure 20CT performed immediately after cranioplasty showing cranial implant in place.
Figure 21MRI performed 9 months after initial surgery showing no recurrent or residual meningioma.

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