Meningioma Extracranial meningioma in the vicinity of the temporal bone: a difficult preoperative diagnosis Amit Agrawal, MCh a, 4 , K.S. Rao d , Jagadeesh H. Makannavar, MD b , Lathika Shetty, MD c , Nehal Patel, MDS e Departments of a Neurosurgery, b Pathology, and c Radiology, KS Hegde Medical Academy, Mangalore 575018, India d Department of Craniomaxillofacial Surgery, Nitte Meenakshi Institute of Craniofacial Surgery, Mangalore 575018, India e AB Shetty Memorial Institute of Dental Sciences, Mangalore 575018, India Received 17 November 2005; accepted 21 February 2006 Abstract Background: Extracranial meningioma is a rare tumor, and most of the time only after histopathologic examination is diagnosis possible. Case Description: A 40-year-old right-handed woman presented with progressive swelling over the right side of the forehead and temporal region associated with proptosis and visual loss. Incisional biopsy of the lesion was reported as spindle cell tumor. Computed tomography scan showed large enhancing predominantly extracranial lesion located in the right anterior frontotemporal region extending into the infratemporal fossa and a relatively thin sheet of tumor on the intracranial aspect of the thickened temporal. Intraoperative impression was malignant tumor involving the temporalis muscle, and a near total excision of the lesion was performed. Histopathologic features were suggestive of meningothelial meningioma arising from the temporal bone with predominant extracranial extension. Conclusion: Preoperative suspicion of a meningioma in this patient would have resulted in a more aggressive surgical approach as these lesions are relatively benign with indolent course. D 2007 Elsevier Inc. All rights reserved. Keywords: Extracranial meningioma; Temporal bone tumor 1. Introduction Extracranial meningioma is an unusual tumor, mainly found in the head and neck area. Most cases occurred in the glabella, bridge of the nose, skin, temporal bone, paranasal sinus, pterygopalatine fossa, and can rarely involve the mandible [13,19]. These lesions are even less commonly reported in the lung [2], mediastinum [24], skin of the finger and eyelid [12], retroperitoneum [10,11], thigh muscle [21], and the foot [22]. Before surgical removal and histopatho- logic examination, this diagnosis is rarely considered [5,17]. Awareness of these relatively benign lesions is very important as it will change the surgical approach. In this case report, we discuss the salient characteristic features of these lesions which can help in preoperative diagnosis and aggressive management of these patients. 2. Case report A 40-year-old right-handed woman presented with progressive swelling over the right side of the forehead and temporal region of 2-year duration. It was associated with local pain, progressive proptosis, and diminution of vision in the right eye. She underwent incisional biopsy 1 year ago, which was reported as spindle cell tumor. On examination, she had an 8 Â 7-cm, firm, nontender, noncompressible swelling on the right temporal region and it was fixed to the underlying bone. The skin over the swelling showed prominent vessels and well-healed scar from a previous biopsy. The skin could be pinched off the underlying mass. The superior and lateral orbital margins were well palpable. She also had significant proptosis of the 0090-3019/$ – see front matter D 2007 Elsevier Inc. All rights reserved. doi:10.1016/j.surneu.2006.02.043 Abbreviation: CT, computerized tomography. 4 Corresponding author. Tel.: +91 824 2204472; fax: +91 824 2204016. E-mail address: dramit _ in@yahoo.com (A. Agrawal). Surgical Neurology 67 (2007) 102 – 105 www.surgicalneurology-online.com