title: Glioblastoma Mimicking Meningioma: Report of 2 Cases.
abstract: BACKGROUND
  Glioblastoma can mimic various pathologies, including arteriovenous malformation, hemorrhage from ischemic stroke, cerebral contusion, metastatic disease, lymphoma, and infection. The literature is limited regarding diagnostic confusion with meningioma. Herein, we present 2 patients that exhibited imaging, including cerebral angiography during preoperative embolization, which was consistent with meningioma, but where final surgical diagnosis revealed glioblastoma.
  
  
  METHODS
  Case 1 was a 57-year-old woman presenting with headache, ataxia, and memory lapses for the past month. Brain magnetic resonance imaging (MRI) demonstrated a heterogeneous-enhancing right temporoparietal mass with broad contact along the right tentorium, cerebrospinal fluid (CSF) cleft sign, and dural tail sign-consistent with meningioma. Patient underwent angiography with successful polyvinyl alcohol foam (PVA) particle embolization of the petrosquamosal branch of the right middle meningeal artery (MMA) and meningeal branch of the right occipital artery, resulting in significant devascularization of the tumor blush. Subsequently, the patient underwent tumor resection, where pathology revealed glioblastoma. Case 2 was a 60-year-old man presenting with right hemiparesis. Brain MRI demonstrated a left parasagittal, heterogeneous-enhancing mass abutting the falx with a dural tail sign-consistent with meningioma. Patient underwent angiography with successful PVA particle embolization of the left MMA, resulting in significant devascularization of the tumor blush. Patient underwent a tumor resection where pathology revealed glioblastoma.
  
  
  CONCLUSIONS
  Glioblastoma can mimic meningioma on MRI with dural tail sign, CSF cleft sign, and broad dural contact. Moreover, cerebral angiography can reveal tumor feeders commonly associated with meningioma. These features can contribute to diagnostic confusion. Based on these 2 cases, preoperative embolization of tumor feeders is possible with glioblastoma.
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Mohit
authors: M
authors: Patel
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address: hsnguyen@mcw.edu.
authors: Ha Son
authors: HS
authors: Nguyen
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Ninh
authors: N
authors: Doan
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Michael
authors: M
authors: Gelsomino
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Saman
authors: S
authors: Shabani
authors: Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors: Wade
authors: W
authors: Mueller
mesh_terms: D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D002533:Cerebral Angiography; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic; D005260:Female; D005909:Glioblastoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging*; D008579:Meningioma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011145:Polyvinyls / Q000627:therapeutic use
chemical_list: D011145:Polyvinyls; C026699:ivalon sponge
keywords: CSF cleft sign; Dural tail sign; Glioblastoma multiforme; Meningioma; Middle meningeal artery; Occipital artery; Preoperative embolization; Spoke wheel sign; Sunburst sign