1. DURAL TUMOURS.
Dr. NIKRISH S HEGDE

2. MENINGIOMA
Most common tumor to originate
from the meninges.
 Most common non glial primary brain
tumor.
M:F 1:2 ; 40 – 60 yrs

3. HISTOLOGY.
Meningothelial cells.
Specialised meningothelial cells known as
arachnoid cap cell.
Few arise from dural fibroblasts.
Choroid plexus and Arachnoid associated
with cranial nerves.

4. CYTOGENETIC.
Chromosome 22
Neurofibromatosis type 2

5. Related to sex hormones.
Common in women, correlated with breast
cancer and increase in size in pregnancy.
Hormonal receptors.

6. GROSS
Globose : spherical or lobulated
Enplaque: flat , carpet like infiltrative lesion.
Sessile / Pedunculated

7. CLASSIC DESCRIPTION
Syncytial
Fibrous
Transitional
Angioblastic

8. WHO CLASSIFICATION
Benign
Atypical
Anaplastic

9. LOCATION
Extra axial dural based lesions.
Majority are supratentorial
Dural venous sinuses, confluence of
cranial sutures & arachnoid granulations.

10. Parasagittal 25%
Convexity 20%
Sphenoid ridge 20%
Olfactory 5%
Para sellar 5%
Posterior fossa 10%

11. C/F
Asymptomatic
10% symptomatic
Depends on the locations

12. Hemiparesis and seizures
Visual field defects
Multiple cranial nerve palsies
Anosmia

13. IMAGING
Plain Film
Angiography
CT
MRI

14. PLAIN FILM
Bone erosions
Hyperostosis
Tumoral calcifications
Enlarged Vascular channels

17. ANGIOGRAPHY
Dual supply
Centrally – Sunburst Pattern &
peripherally by pial branches
Late phase – mother in law sign

21. CT
Well circumscribed lobulated mass
Abuts the dural surface at obtuse angle.
Majority are hyperdense
Calcification and bone destruction
Edema

22. NECT
90% homogenous enhancement
5-10% rim like enhancement
 Inhomogeneous enhancementmushrooming

27. MRI
CSF cleft
Displaced grey white matter interface
4 th ventricle compressed
Ipsilateral CPA Cistern enlarged

28.  T1 -
isointense: ~ 60-90%
somewhat hypointense: ~ 10-40%
compared to grey matter

29. T2 isointense: ~ 50%
hyperintense: ~ 35-40%
very hyperintense lesions may represent the
microcystic variant 12
hypointense: ~ 10-15% compared to grey matter

30. T1 C+ (Gd) - usually intense and
homogenous enhancement.
Moderate to severe peritumoral edema.
Dural tail sign.

38. DURAL TAIL SIGN
occurs as a result of thickening of the dura

42. 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

43. HEMANGIOPERICYTOMA
“Uncertain origin”
Well circumscribed lesions
Highly Vascular.

44. 40-60 yrs
Male preponderance
Show recurrences and extra neural
metastasis.

45. ANGIOGRAPHY
Hypervascular
Heterogeneous tumor stain
Dual Supply

47. CT
NECT – Heterogeneous
CECT – Heterogeneous enhancement
Cystic and necrotic areas

48. MRI
Extra axial
T1 – Iso
PD – Hyper
T2 - Hetero
Shows inhomogenous enhancement.

51. MELANOCYTOMA
Benign tumours.
Leptomeningeal melanocytes.
Locations - Foramen magnum, the posterior
fossa, Meckel’s cave, or adjacent to cranial nerve
nuclei.

52. C/F
4th – 5th decade
Size & Location.
Pain , weakness & sensory defecits.

53. CT
NECT - hyper
well defined lesion
 CECT – Homogeneous enhancement.

54. MRI
T1 : isointense or hyperintense
T2 : isointense or hypointense
T1 C+ (Gd) : heterogenous enhancement
T2* GRE : may show blooming of low signal

59. DURAL METS
 solid tumours
 lung cancer
 breast cancer
 melanoma
 haemopoietic neoplasms
 lymphoma
 leukaemia

60. CT

62. MRI

70. THANK YOU 