DURAL TUMOURS.
Dr. NIKRISH S HEGDE
MENINGIOMA
Most common tumor to originate
from the meninges.
Most common non glial primary brain
tumor.
M:F 1:2 ; 40 – 60 yrs
HISTOLOGY.Meningothelial cells.
Specialised meningothelial cells
known as arachnoid cap cell.
Few arise from dural fibroblasts.
Choroid plexus and Arachnoid
associated with cranial nerves.
CYTOGENETIC.
Chromosome 22
Neurofibromatosis type 2
Related to sex hormones.
Common in women, correlated with
breast cancer and increase in size in
pregnancy.
Hormonal receptors.
GROSS
Globose : spherical or lobulated
Enplaque: flat , carpet like infiltrative lesion.
Sessile / Pedunculated
CLASSIC DESCRIPTION
Syncytial
Fibrous
Transitional
Angioblastic
WHO CLASSIFICATION
Benign
Atypical
Anaplastic
LOCATION
Extra axial dural based lesions.
Majority are supratentorial
Dural venous sinuses, confluence of
cranial sutures & arachnoid
granulations.
Parasagittal 25%
Convexity 20%
Sphenoid ridge 20%
Olfactory 5%
Para sellar 5%
Posterior fossa 10%
C/F
Asymptomatic
10% symptomatic
Depends on the locations
Hemiparesis and seizures
Visual field defects
Multiple cranial nerve palsies
Anosmia
IMAGING
Plain Film
Angiography
CT
MRI
PLAIN FILM
Bone erosions
Hyperostosis
Tumoral calcifications
Enlarged Vascular channels
ANGIOGRAPHY
Dual supply
Centrally – Sunburst Pattern &
peripherally by pial branches
Late phase – mother in law sign
CT
Well circumscribed lobulated mass
Abuts the dural surface at obtuse angle.
Majority are hyperdense
Calcification and bone destruction
Edema
NECT
90% homogenous enhancement
5-10% rim like enhancement
Inhomogeneous enhancement-
mushrooming
MRI
CSF cleft
Displaced grey white matter
interface
4 th ventricle compressed
Ipsilateral CPA Cistern enlarged
T1 -
isointense: ~ 60-90%
somewhat hypointense: ~ 10-
40% compared to grey matter
T2 -
isointense: ~ 50%
hyperintense: ~ 35-40%
very hyperintense lesions may
represent the microcystic variant 12
hypointense: ~ 10-15% compared to
grey matter
T1 C+ (Gd) - usually intense and
homogenous enhancement.
Moderate to severe peritumoral
edema.
Dural tail sign.
DURAL TAIL SIGN
occurs as a result of thickening of the
dura
DWI
atypical and malignant sub types may
show greater than expected restricted
diffusion although recent work suggests
that this is not useful in prospectively
predicting histological grade
HEMANGIOPERICYTOMA
“Uncertain origin”
Well circumscribed lesions
Highly Vascular.
40-60 yrs
Male preponderance
Show recurrences and extra
neural metastasis.
ANGIOGRAPHY
Hypervascular
Heterogeneous tumor stain
Dual Supply
CT
NECT – Heterogeneous
CECT – Heterogeneous
enhancement
Cystic and necrotic areas
MRI
Extra axial
T1 – Iso
PD – Hyper
T2 - Hetero
Shows inhomogenous enhancement.
MELANOCYTOMA
Benign tumours.
Leptomeningeal melanocytes.
Locations - Foramen magnum, the
posterior fossa, Meckel’s cave, or
adjacent to cranial nerve nuclei.
C/F
4th – 5th decade
Size & Location.
Pain , weakness & sensory
defecits.
CT
NECT - hyper
well defined lesion
CECT – Homogeneous
enhancement.
MRI
T1 : isointense or hyperintense
T2 : isointense or hypointense
T1 C+ (Gd) : heterogenous enhancement
T2* GRE : may show blooming of low
signal
DURAL METSsolid tumours
lung cancer
breast cancer
melanoma
haemopoietic neoplasms
lymphoma
leukaemia
CT
MRI
THANK YOU