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AJNR - American Journal of Neuroradiology

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Glioblastoma Multiforme Causing Calvarial Destruction: An Unusual Manifestation Revisited

Vinay Gheyi^a, Ferdinand K. Hui^c, Egon M. Doppenberg^b, William Todd^d and William C. Broaddus^b

^a Department of Radiology, Medical College of Virginia, Richmond, VA
^b Department of Neurosurgery, Medical College of Virginia, Richmond, VA
^c Hunter Holmes McGuire Dept of Veteran’s Affairs, and the Department of Radiology, Medical College of Virginia, Richmond, VA
^d Department of Pathology, Medical College of Virginia, Richmond, VA

View larger version (44K): [in a new window]   FIG 1. CT scans. A and B, Nonenhanced scans obtained at slightly different heights show a rounded heterogeneous mass in the right frontoparietal region (arrow). C, Higher section shows inward dural displacement (arrow) and overlying calvarial destruction, suggesting extra-axial extension of the mass.

View larger version (63K): [in a new window]   FIG 2. Bone window settings from the same nonenhanced CT study as in Figure 1 shows calvarial destruction (arrow).

View larger version (52K): [in a new window]   FIG 3. MR images demonstrate intra- and extra-axial locations of the mass eroding through the calvaria (arrow). Note inward displacement of the hypointense dura. A, T2-weighted image. B, T1-weighted image. C, Gadolinium-enhanced T1-weighted image.

View larger version (160K): [in a new window]   FIG 4. Sequential T2-weighted images demonstrate no definite gross violation of the dura.

View larger version (95K): [in a new window]   FIG 5. Tumor eroding through the bone before the bone flap was created.

View larger version (113K): [in a new window]   FIG 6. Epidural tumor leaving the dura macroscopically intact without substantial dural adherence.

View larger version (64K): [in a new window]   FIG 7. Macroscopically intact dura after the epidural portion of tumor was removed.

View larger version (64K): [in a new window]   FIG 8. Intracerebral component is visible and surrounded by normal cortex.

View larger version (106K): [in a new window]   FIG 9. Right parietal dura with tumor (arrows) on both sides of the dura (original magnification x40).

View larger version (106K): [in a new window]   FIG 10. Right parietal intracerebral tumor (arrow). Image shows the GBM arising in the brain and growing outward as a mass outside the brain that penetrated the dura and the skull (original magnification x20).

View larger version (106K): [in a new window]   FIG 11. Right parietal tumor shows positivity for immunoperoxidase staining against GFAP (original magnification x40).