[Giant intra-extracranial meningioma of the calvaria].

A 30 year old woman presented with a tumor of calvaria which had grown slowly over a period of 10 years. There was no history of symptoms other than an isolated episode of seizure. Infiltration of the scalp noted at physical examination and radiologic findings suggested the diagnosis slowly progressive sarcoma but the diagnosis of meningioma was established by histologic examination which also showed the important vascularization of the tumor (estimated blood loss was 300cm3). Taking into consideration the histologic benignity of the tumor and the complete thrombosis of the longitudinal sinus, removal of the lesion was planned after complete embolization of the vessels branching from the external carotid artery to supply the tumor. A two stage procedure was performed. During the first operative stage portion of the meningioma infiltrating the bone (800 g; 15 X 12 X 2 cm) and scalp was removed. In as second stage the intracranial "en plaque" meningioma was removed with no significant bleeding. The resected dura was replaced by combining a pericranial graft with a dermal graft. The cranial valt was restored with a bone homograft. The patient tolerated the procedure well and is in good health 18 months following surgery.