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P134: BEYOND THE DURA-EXTENSIVE HYPEROSTOTIC RESPONSE IN A GIANT INTRACRANIAL MENINGIOMA: A CASE REPORT AND REVIEW
MacKenzie S Thomas, BS; MacGregor C Thomas, BS; Kari O'Toole, DNP, APRN, CNP; Christopher S Graffeo, MD, MS; University of Oklahoma Health Sciences Center

Introduction: Meningiomas account for approximately 41% of all primary CNS neoplasms in the United States. Although local bony changes are frequently observed adjacent to intracranial meningiomas, extensive calvarial hyperostosis is exceedingly rare. We report a patient presenting with a 14 year history of pan-cranial hyperostosis from a bilateral parasagittal meningioma, as well as an associated systematic review. 

Objective: To report a case of massive cranial hyperostosis as well as to summarize the pertinent neurosurgical literature. 

Methods: Case report and PRISMA-compliant systematic review. 

Results: A female in her mid-40s presented with more than 14 years of enlarging pan-calvarial skull deformity involving the bilateral frontal bones. MRI revealed an extensive midline enhancing mass arising from the falx and paramedian convexity dura, consistent with meningioma. The patient underwent bifrontal craniotomy with en bloc resection of hyperostotic bone and microsurgical removal of a giant bilateral parafalcine meningioma. Subtotal resection was performed to preserve critical venous drainage near the superior sagittal sinus. Reconstruction included dural grafting and titanium mesh cranioplasty. Pathologic analysis confirmed a meningothelial meningioma (WHO Grade II) with a solitary TRAF7 mutation. Systematic review indicated a high prevalence of bifrontal bony involvement and meningothelial histology. 

Conclusion: Mutations in TRAF7, a potent regulator of NF-κB, MAPK, and similar pathways, have been linked to hyperostosis in the calvarium, as well as meningothelial meningioma histopathology. The present case report and literature review highlight the potentially profound impact of a TRAF7 mutation in meningioma paracrine hyperostosis, although further study is required to better understand the mechanistic interplay between TRAF7, hyperostosis, and meningioma phenotype.

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