Six different extremely calcified lesions of the brain: brain stones

Abstract

Background: This study aimed to extend clinical documentation of cerebral calculi by reporting six cases of cerebral calculi with distinct etiologies and localizations.

Methods: We evaluated the age, sex distribution, presenting symptoms, neurological examination findings, pathology results, and location of the calcifications of six patients with intracranial calcifications.

Results: Three of the six patients with brain stones were female (50%), and three were male (50%). The patient ages ranged from 12 to 46 years. A radiological examination of each patient's cranium was performed with pre-operative cranial computed tomography and magnetic resonance imaging. All of the lesions were completely excised. The patients' pathologies were determined to be distinct hyalinization, dystrophic calcification, hamartoma, ossification developing from widespread pituitary adenoma tissue, benign mesenchymal neoplasia, a mass consisting of sporadically ossified fibrous tissue, and angiomatous meningioma with distinct hyalinization and fibrosis.

Conclusions: Intracranial calcifications are a common phenomenon in neurosurgical practice. However, brain stones, as well as solid calcifications also termed cerebral calculi, are rarely encountered. Brain stones can be classified on the basis of their etiology and localization. Additionally, we suggest that lesions smaller than 1 cm might be classified as calcifications and those greater than 1 cm as brain stones. We further suggest that the differentiation between calcification and brain stones might be based on size. These pathologies typically manifest as seizures and are occasionally identified during routine brain tomography. Meningiomas constitute an important portion of extra-axial calcifications, whereas tumorous and vascular causes are more prevalent among intra-axial calcifications.

Keywords: Aneurysm; Angiomatous meningioma; Benign mesenchymal neoplasm; Cerebral calculi; Hamartoma; Pituitary stone.

Fig. 1

a, b Contrast-enhanced T2A and T1A images of the patient

Fig. 2

a, b The lesion was observed on the axial and coronal sections of a preoperative paranasal sinus CT of the patient

Fig. 3

The lesion upon dissection. The connection of the aneurism with the basilar artery and the vortex formed by the blood circulation are clearly detectable

Fig. 4

Axial T2A view of the formation

Fig. 5

Cranial CT view of the formation

Fig. 6

Formation as it was accessed via Sylvian dissection

Fig. 7

The lesion and the surrounding calcified tissue after removal

Fig. 8

Unenhanced BT section showing ossification within a mass located in the sellar and suprasellar cisterns

Fig. 9

Enhanced sagittal T1 MR image of the patient. Sporadically hypointense areas indicative of calcification are detectable

Fig. 10

Contrast-enhanced coronal T1A image. Erosion of the sellar floor by the lesion is observed, and the mass extends into the sphenoid sinus, infiltrates into the left cavernous sinuses, compresses the optic chiasm, and surrounds the carotid artery

Fig. 11

a, b Contrast-enhanced T2A and T1A MR images of the patient. Contrast uptake into the lesions is clearly detectable

Fig. 12

Calcification is clearly detectable in the bone window of the preoperative brain CT image of the patient

Fig. 13

Preoperative BT image of the patient

Fig. 14

Cranial MRI of the patient prior to the 2nd operation

Fig. 15

a, b Preoperative cranial MRI of the patient. T1A and T2A sections show a clearly contrast-enhanced hypo- and hyper-intense lesion at the right posterior parietal vertex

Fig. 16

Preoperative cranial CT image of the patient

Fig. 17

a, b Images of the tumor removed as two separate components. Vascular tissue is observed upon dissection of the tumor along the sagittal plane