Neurology India Medknow Publications on behalf of the Neurological Society of India ISSN: 0028-3886 EISSN: 1998-4022 Vol. 59, Num. 2, 2011, pp. 309-310

Neurology India, Vol. 59, No. 2, March-April, 2011, pp. 309-310

Letter to Editor

Bilateral "mirror" cystic meningiomas: A rare radiological presentation

Hrishikesh Sarkar, Siddhartha Ghosh

Division of Neurosurgery, Apollo Speciality Hospital, No. 320, Mount Road, Teynampet, Chennai - 600 035, India

Correspondence Address: Siddhartha Ghosh, Division of Neurosurgery, Apollo Speciality Hospital, No. 320, Mount Road, Teynampet, Chennai - 600 035, India, siddhartha_ghosh@hotmail.com

Date of Submission: 23-Dec-2010
Date of Decision: 23-Dec-2010
Date of Acceptance: 23-Dec-2010

Code Number: ni11090

PMID: 21483149

DOI: 10.4103/0028-3886.79168

Sir,

A 42-year-old male presented with features of raised intracranial pressure of 3 months duration. Contrast magnetic resonance imaging (MRI) of brain showed a dural-based, midline enhancing, plaque-like mass in the anterior one-third parasagittal region with extratumoral cysts on both sides, mirror-image of each other [Figure - 1]a-c. Patient underwent bifrontal craniotomy and Simpson's grade 1 excision of the mass. Intraoperatively, a firm, dural-based mass was located in the midline involving the anterior third of the superior sagittal sinus. The extratumoral cyst present on either side contained clear cerebrospinal fluid (CSF) like fluid. These cysts were separate from the ventricular system. The biopsy was reported as meningioma. The cyst wall did not appear to contain neoplastic cells. The patient made a good recovery [Figure - 1]d.

Cystic meningioma are a rare entity. ^{[1],[2],[3],[4]} These tumors occur mostly unilaterally and can be mistaken for glial or metastatic tumors and hemangioblastoma. ^[1] The tumor in our patient had unique radiological features. This anterior one-third parasagittal meningioma had two extratumoral cysts on either side of the falx, compressing both the frontal horns. The cyst contained clear CSF like fluid. The cyst wall was negative for tumor cells. As per the classification proposed by Nauta and Rengachary, this tumor could be classified as Type III. This is the first ever documented case of bilateral Nauta III cystic meningioma arising from a common dural attachment, presenting with typical imaging features. Several mechanisms have been proposed for cyst formation. In our case, the secretory function of the solid component and the glial reactionary change in the adjacent brain seems to be the most possible mechanism. Evagination of arachnoid by the tumor on both sides of the superior sagittal sinus, that too, at the same location, seems to be a less likely process.

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