Abstract：
Intradiploic meningiomas are rare neoplasms, often mistaken for metastases or malignant bone tumors. Surgical management can be challenging, considering their diffusive bony invasion. Two main critical decisions need to be taken: the timing for cranial vault reconstruction and the choice of the adequate material for cranioplasty. We believe that this case underscores the complexity of such lesions, the importance of a prompt devascularization, and the pivotal role of an immediate reconstruction to avoid the additional morbidity of a re-do surgery. Here, we report a case of 68-year-old men who presented with slow growing right parietal bone swelling he noted many years before, but for which he didn\'t seek medical attentions, associated with mild contralateral hemiparesis. Neuroradiological examinations revealed a giant extradural intradiploic tumor affecting the right temporo-parietal bone and conditioning significant compression of the underlying brain. We planned a surgical strategy to deafferent the tumor and to reduce the intraoperative bleeding. At first, a circumferential craniectomy centered upon the lesion was performed, then it was devascularized by means of surgical ligation of the ipsilateral superficial temporal artery (STA) and middle meningeal artery (MMA); these steps allowed a subsequent en block tumor excision, despite its large size, without significant blood loss and respecting the oncological principles. At the end, a contextual calvarial reconstruction was performed using a precurved titanium mesh. The patient was discharged seven days after surgery with complete recovery of the left-sided motor deficit. Thereafter, he underwent scheduled outpatient evaluations and radiological examinations. At 1-year follow-up, the Modified Rankin Scale (MRS) was 1, with no evidence of recurrent disease. To conclude, surgical complications can be reduced adopting an optimal preoperative work-up and a tailored surgical strategy focused on early tumor deafferentation. Moreover, an immediate cranial vault reconstruction avoids the risks related to a second procedure.
摘要：
目的：染色体内脑膜瘤是一种罕见的肿瘤，常被误认为转移瘤或恶性骨肿瘤。手术管理可能具有挑战性，考虑到它们的扩散性骨入侵。需要做出两个主要的关键决定：颅骨穹顶重建的时机和颅骨成形术的适当材料的选择。我们认为这个案例凸显了这种病变的复杂性,迅速断流的重要性，以及立即重建的关键作用，以避免再次手术的额外发病率。
方法：我们报告了一个68岁的男性患者，他多年前注意到他的右顶骨肿胀缓慢增长，但他没有寻求医疗护理，伴有轻度对侧偏瘫。神经放射学检查显示，一个巨大的硬膜外内肿瘤影响了右颞顶骨，并对基础大脑进行了显着压缩。我们计划了一种手术策略，以使肿瘤传入神经并减少术中出血。起初,进行了以病变为中心的环形颅骨切除术，然后通过手术结扎同侧颞浅动脉（STA）和脑膜中动脉（MMA）进行血运重建；这些步骤允许随后进行肿瘤切除，尽管尺寸很大，没有明显的失血和尊重肿瘤的原则。最后,使用预弯曲的钛网进行上下文颅骨重建。
结果：手术后7天出院，左侧运动障碍完全恢复。此后,他接受了预定的门诊评估和放射学检查。一年后，改良Rankin量表（MRS）为1，无疾病复发的证据。
结论：采用最佳的术前检查和专注于早期肿瘤切除的量身定制的手术策略可以减少手术并发症。此外，立即进行颅穹顶重建避免了与第二次手术相关的风险。
方法：我们报告了一个68岁的男性患者，他多年前注意到他的右顶骨肿胀缓慢增长，但他没有寻求医疗护理，伴有轻度对侧偏瘫。神经放射学检查显示，一个巨大的硬膜外内肿瘤影响了右颞顶骨，并对基础大脑进行了显着压缩。我们计划了一种手术策略，以使肿瘤传入神经并减少术中出血。起初,进行了以病变为中心的环形颅骨切除术，然后通过手术结扎同侧颞浅动脉（STA）和脑膜中动脉（MMA）进行血运重建；这些步骤允许随后进行肿瘤切除，尽管尺寸很大，没有明显的失血和尊重肿瘤的原则。最后,使用预弯曲的钛网进行上下文颅骨重建。
结果：手术后7天出院，左侧运动障碍完全恢复。此后,他接受了预定的门诊评估和放射学检查。一年后，改良Rankin量表（MRS）为1，无疾病复发的证据。
结论：采用最佳的术前检查和专注于早期肿瘤切除的量身定制的手术策略可以减少手术并发症。此外，立即进行颅穹顶重建避免了与第二次手术相关的风险。
