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Peer-reviewedCC BY-NC-ND 4.0Journal of Neurosurgery: Case Lessons

Primary intraosseous meningioma of the parasagittal region with continuous transcalvarial progression: illustrative case

  • Kazuaki Okamura1
  • Eri Shiozaki1
  • Hiroko Hayashi2
  • Mitsuto Iwanaga1
  1. 1Department of Neurosurgery, Sasebo City General Hospital, Sasebo City, Nagasaki
  2. 2Department of Pathology, Sasebo City General Hospital, Sasebo City, Nagasaki, Japan
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Abstract

BACKGROUND: Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningioma arising within the cranial bones. Distinguishing true PIM from conventional meningioma with secondary osseous involvement remains challenging, and pathological evidence demonstrating continuous transcalvarial tumor involvement is rarely documented.

OBSERVATIONS: A 74-year-old man receiving maintenance hemodialysis presented with progressive gait disturbance and cognitive decline. Serial imaging over 2.5 years demonstrated progression from a predominantly calvarial lesion with an associated extracranial scalp component to extensive intracranial extension, accompanied by chronic superior sagittal sinus (SSS) occlusion and marked collateral venous remodeling. Following preoperative embolization, subtotal resection was performed while preserving the chronically occluded SSS. Histopathological analysis revealed transitional meningioma (CNS WHO grade 1) with continuous infiltration of the subcutaneous tissue, calvarial marrow spaces, dura, and intradural compartment. Despite CNS WHO grade 1 histology, rapid local tumor recurrence measuring approximately 42 mm developed within 5 months after surgery.

LESSONS: Although histological continuity alone cannot establish the site of origin or direction of tumor spread, the predominantly calvarial involvement on initial imaging and subsequent intracranial progression favored a primary intraosseous origin. Recognition of this growth pattern and associated chronic venous remodeling may facilitate accurate diagnosis, surgical planning, and postoperative surveillance.

https://thejns.org/doi/10.3171/CASE26765

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Cite

BibTeXRIS
BibTeX
@article{okamura2026primary,
  title = {{Primary intraosseous meningioma of the parasagittal region with continuous transcalvarial progression: illustrative case}},
  author = {Kazuaki Okamura and Eri Shiozaki and Hiroko Hayashi and Mitsuto Iwanaga},
  journal = {Journal of Neurosurgery: Case Lessons},
  year = {2026},
  month = oct,
  doi = {10.3171/case26765},
  url = {https://doi.org/10.3171/case26765},
  note = {CC BY-NC-ND 4.0},
}
RIS
TY  - JOUR
TI  - Primary intraosseous meningioma of the parasagittal region with continuous transcalvarial progression: illustrative case
AU  - Kazuaki Okamura
AU  - Eri Shiozaki
AU  - Hiroko Hayashi
AU  - Mitsuto Iwanaga
PY  - 2026
DA  - 2026/10/26
JO  - Journal of Neurosurgery: Case Lessons
DO  - 10.3171/case26765
UR  - https://doi.org/10.3171/case26765
AB  - BACKGROUND: Primary intraosseous meningioma (PIM) is a rare subtype of extradural meningioma arising within the cranial bones. Distinguishing true PIM from conventional meningioma with secondary osseous involvement remains challenging, and pathological evidence demonstrating continuous transcalvarial tumor involvement is rarely documented.  OBSERVATIONS: A 74-year-old man receiving maintenance hemodialysis presented with progressive gait disturbance and cognitive decline. Serial imaging over 2.5 years demonstrated progression from a predominantly calvarial lesion with an associated extracranial scalp component to extensive intracranial extension, accompanied by chronic superior sagittal sinus (SSS) occlusion and marked collateral venous remodeling. Following preoperative embolization, subtotal resection was performed while preserving the chronically occluded SSS. Histopathological analysis revealed transitional meningioma (CNS WHO grade 1) with continuous infiltration of the subcutaneous tissue, calvarial marrow spaces, dura, and intradural compartment. Despite CNS WHO grade 1 histology, rapid local tumor recurrence measuring approximately 42 mm developed within 5 months after surgery.  LESSONS: Although histological continuity alone cannot establish the site of origin or direction of tumor spread, the predominantly calvarial involvement on initial imaging and subsequent intracranial progression favored a primary intraosseous origin. Recognition of this growth pattern and associated chronic venous remodeling may facilitate accurate diagnosis, surgical planning, and postoperative surveillance.  https://thejns.org/doi/10.3171/CASE26765
SN  - 2694-1902
ER  -