背景:斑块状脑膜瘤(EPM)由于其非典型的放射学特征,在术前诊断方面存在挑战。此病例报告描述了在确定影响其手术管理的EPM方面的术前诊断挑战。
方法:一名58岁的女性患者因意识下降和两个月前头部跌倒的历史而出现在急诊科。在过去的一年里,病人还抱怨头痛恶化。一周前,病人还抱怨恶心,呕吐,和波动的发烧。尽管头部CT扫描显示左侧颞顶区有肿块,患者最初被诊断为亚急性硬膜下血肿(saSDH),并计划使用毛刺孔技术进行SDH排空手术。然而,术中发现硬膜外颅内肿瘤,所以手术改为肿瘤切除开颅手术,根据组织病理学检查,证实是间变性恶性脑膜瘤,世卫组织三级。
结论:EPM是脑膜瘤的罕见亚型之一,具有非典型和放射学上可变的外观,通常在术前诊断中提出挑战。在这种情况下,患者头部跌倒史和头部CT扫描类似于saSDH可能会掩盖术前诊断并影响患者的治疗.
结论:EPM可以像其他颅内疾病一样表现。在这种情况下,患者的跌倒史可能会掩盖临床医生对脑膜瘤的诊断,导致术前误诊为saSDH。因此,细致的术前诊断对于确定患者的治疗和预后至关重要。
BACKGROUND: En-plaque meningioma (EPM) presents preoperative diagnostic challenges due to its atypical radiologic features. This case report describes the preoperative diagnostic challenges in identifying EPM that affected its operative management.
METHODS: A 58-year-old female patient presented to the emergency department with decreased consciousness and a history of a fall on the head two months earlier. For the past year, the patient also complained of worsening headaches. One week before, the patient also complained of nausea, vomiting, and fluctuating fever. Although a CT scan of the head showed a mass in the left temporoparietal region, the patient was initially diagnosed with subacute subdural hematoma (saSDH) and planned for SDH evacuation surgery using the burr hole technique. However, intraoperative findings revealed an extradural intracranial tumor, so the procedure was switched to tumor excision craniotomy, and based on histopathological examination, it was confirmed to be an anaplastic malignant meningioma, WHO grade III.
CONCLUSIONS: EPM is one of the rare subtypes of meningioma with an atypical and radiologically variable appearance that often presents challenges in preoperative diagnosis. In this case, the patient\'s history of falling on the head and the CT scan of the head that resembles saSDH may obscure the preoperative diagnosis and affect the patient\'s management.
CONCLUSIONS: EPM can manifest like other intracranial disorders. In this case, the patient\'s fall history may obscure the clinicians\' diagnosis of the meningioma, leading to preoperative misdiagnosis with saSDH. Therefore, meticulous preoperative diagnosis is essential to determining the patient\'s medical treatment and outcome.