Giant occipital intracranial and extracranial meningioma

Rodney S Allan, Peter J Spittaler and Lindsay J Rowe
Med J Aust 2003; 179 (8): 448. || doi: 10.5694/j.1326-5377.2003.tb05630.x
Published online: 20 October 2003

A 17-year-old man presented with a history of several months of constant, throbbing headaches. He had always had long hair, concealing an obvious skull deformity that had not previously been noticed.

Examination revealed a visible occipital deformity of the skull (Box, A). He had chronic papilloedema, with a visual acuity of 6/60 within markedly contracted visual fields. There were no other neurological abnormalities.


X-rays, computed tomography and magnetic resonance imaging further delineated the anatomy of the lesion (Box, B,C). Volume estimation1 yielded a total volume of 1094 cm3, making this one of the largest meningiomas ever reported.


Meningiomas account for about 20% of all intracranial tumours3 and, as slow-growing tumours that display benign behaviour, can escape notice.

Hyperostosis is often palpable through the scalp, but this patient had an unusually large extracranial volume of tumour (more commonly associated with malignant meningiomas,4 which often lack a significant intracranial component).

Complete surgical excision of meningiomas has been shown to offer the best long-term outcome compared with subtotal excision with or without radiotherapy.5 However, even with optimum surgical excision, recurrence rates of up to 20% can be expected over a 20-year period.6

  • Rodney S Allan1
  • Peter J Spittaler2
  • Lindsay J Rowe3

  • 1 Department of Neurosurgery, Westmead Hospital, Westmead, NSW.
  • 2 John Hunter Hospital, New Lambton, NSW.


  • 1. Siemens statistical package. Somatom Plus 4 computed tomography scanner. Munich, Germany: Siemens Medical Solutions, 1998.
  • 2. Simpson D. The recurrence of intracranial meningioma after surgical treatment. J Neurol Neurosurg Psychiatry 1957; 20: 22-39.
  • 3. Longstreth WT Jr, Dennis LK, McGuire VM, et al. Epidemiology of intracranial meningioma. Cancer 1993; 72: 639-648.
  • 4. Younis G, Sawaya R. Intracranial osteolytic malignant meningiomas appearing as extracranial soft-tissue masses. Neurosurgery 1992; 30: 932-935.
  • 5. Condra KS, Buatti JM, Mendenhall WM, et al. Benign meningiomas: primary treatment selection affects survival. Int J Radiat Oncol Biol Phys 1997; 39: 427-436.
  • 6. McCarthy BJ, Davis FG, Freels S, et al. Factors associated with survival in patients with meningioma. J Neurosurg 1998; 88: 831-839.


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