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Calcifying pseudoneoplasms of the neuraxis (CAPNON): meta-analysis of all published intracranial cases
Conference Paper/Poster - May 27, 2013
Stienen Martin N., Abdulazim Amr, Gautschi Oliver P, Schneiderhan T M, Hildebrandt Gerhard, Lücke Sebastian
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Case presentation:
Imaging studies:
A: Axial preop MRI in T2-weighted imaging (WI) displayes central susceptibility artefacts and a rim contrast enhancement
B: Sagital MRI in T2-WI
C: Postoperative CT scan 12 h after surgery shows a remaining single calcification
F, G: MRI control 10 months postoperative shows no tumour progression with residual scarring
Intraoperative view:
D: we observed marked perilesional hypervascularisation
E: the dense calcifications constitute the characteristic feature of CAPNON
Histopathological images:
A: Amorphous calcifying masses with osseous metaplasia and fibrovascular stroma of the lesion obtained at surgery (haematoxylin-eosin, original magnification ×100)
B: The tissue was obtained during surgery of a different patient. Amorphous calcifying masses with palisading epithelioid cells. Note the adjacent cerebral tissue on the upper right (haematoxylin- eosin, original magnification ×200)
Metaanalysis:
Epidemiology
- 22 patients reported in the literature
- 14 male (63.6 %) and 8 female (36.7 %)
- mean age 45.0 years (range: 6–67 years)
- 19 supratentorial (7 temporal, 4 frontal, 3 parietal, 3 skull base) / 3 infratentorial
- 14 (63.6%) intra- and 8 (36.4%) extra-axially
Presentation:
- 8 epileptic seizures (36.4 %)
- 5 headache (22.7 %)
- 4 cranial nerve affection (18.2 %)
- each 3 dizziness and limb paresis
- other (incl. 2 incidental findings (9.1%))
Diagnosis:
CT:
- calcifications in 100%
- enhancing on contrast medium (CM)
MRI:
- 77.8% appear hypointense in T1WI
- 88.9% appear hypointense in T2WI
- 90% enhance on CM application
Treatment:
- complete resection possible in 15 of 22 cases (68.2 %)
- incomplete resection in 7 cases (31.8 %)
- revision surgery necessary in 1 case
Outcome:
- median follow-up (FU): 51.5 months (range: 5–360 months) in 16 patients (72.7%)
- 15 patients (93.7 %) recurrence-free at last FU
- no death related to CAPNON during FU
- 10 complete and 5 incomplete resections led to stable condition of the disease (p=0.3749)
Conclusion:
- CAPNON are rare benign lesions of the CNS
- important differential diagnosis in intracranial calcified lesions