A case of microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa

Abstract

A 53-year-old woman was brought to the emergency room with headache and progressive deterioration of consciousness. Radiological examinations revealed acute subdural hematoma extending along the cerebellar tentorium to the falx cerebri, and a mass lesion with hemorrhage in the left cerebellum, with acute hydrocephalus. Emergency tumor and hematoma removal with decompressive craniectomy of the occiput was performed. Histopathological diagnosis was microcystic meningioma. Postoperatively, the patient recovered to clear consciousness with sequelae of left cerebellar ataxia, cerebellar dysarthria, and vertigo. This case of tentorial microcystic meningioma associated with acute subdural hematoma in the posterior cranial fossa is extremely rare, with only reported 4 similar cases.

Keywords: Brain neoplasm; Intracranial hemorrhage; Meningioma; Pathology; Posterior cranial fossa; Surgery.

Fig. 1

Precontrast computed tomography scans of the head showing (A) a hemorrhagic mass lesion in the left cerebellar hemisphere (arrow) and acute subdural hematoma extending along the cerebellar tentorium (arrowheads), and (B) slightly enlarged ventricles with acute subdural hematoma extending along the falx cerebri (arrowhead).

Fig. 2

Precontrast magnetic resonance (MR) images of the head showing hypointensity on the T1-weighted image (A), hyperintensity on the T2-weighted image (B), and intratumoral bleeding on the heavy T2-weighted image (C, arrow). Postcontrast MR images showing heterogeneous enhancement of the mass attached to the left cerebellar tentorium (D-F). Note that the supratentorial extension of the tumor was clearly demonstrated on E (arrow).

Fig. 3

Digital subtraction angiograms of the left external carotid artery, anteroposterior view (A) and lateral view (B), showing partial tumor staining from the left middle meningeal artery (arrows). Digital subtraction angiograms of the left vertebral artery, anteroposterior view (C) and lateral view (D), showing no feeding artery and occlusion of the left transverse sinus (E, arrow).

Fig. 4

Postoperative magnetic resonance images, axial (A), coronal (B), and sagittal views (C), showing the tumor and hematoma have been largely removed.

Fig. 5

Photomicrographs of the surgical specimens with hematoxylin-eosin staining showing tumor cell proliferation against a background of bleeding components (A), microcystic components (B), and nuclear atypia (C, arrow). Immunohistochemical staining showing positive epithelial membrane antigen staining (D), negative glial fibrillary acidic protein staining (E), and Ki-67 index of <1% (F).