Intracranial Meningiomas: A Roentgen Study of 126 Cases

The literature dealing with intracranial meningiomas is voluminous. A large number of articles and monographs have appeared through the years describing the pathology, common locations, clinical features, roentgen findings, and treatment of these tumors. Some of the studies are classic and best read in the original (1–19). In this presentation it is our purpose to evaluate our own material, which consists of 126 proved cases, each including one or more intracranial meningiomas, seen at Montefiore Hospital (New York) in the past thirteen years, and to describe certain roentgen criteria characteristically observed in these lesions. Plain-film evaluation will be emphasized. The use of air studies will be briefly mentioned. The importance of cerebral angiography will be stressed, and the advantages of the biplane method of cerebral angiographic examination will be fully discussed. Technics Conventional Roentgenography: Our standard plain-film examination includes stereoscopic postero-anterior, stereoscopic left lateral, single right lateral, anteroposterior Towne-Chamberlain and, in special situations, submentovertex views. Air Studies: Roentgenograms are obtained in both the horizontal and erect positions in stereoscopic pairs. Stereoscopic brow-down and brow-up views are made, as well as special horizontal-beam temporal horn projections. A Robertson position is added for delineation of the fourth ventricle, and a midline laminagraphic cut for outlining the midline structures, particularly the aqueduct and fourth ventricle. Cerebral Angiography: Prior to 1956, cerebral angiography was performed in our department with the Fairchild camera, with 9 × 9-inch roll film. For the past two years, we have been using a biplane Schönander film-changing device incorporating two 500-ma generators with 14 × 14-inch cut film, permitting up to thirty exposures in each of the two planes simultaneously. Each sequence may be run as slowly as three films per two seconds, and as rapidly as six films per second. With the patient supine on a special sliding top which fits over the Bucky table, the anteroposterior beam is directed downward (36-inch distance). The head is positioned 3 inches from the anteroposterior film changer. The lateral beam (also 36-inch distance) is directed across the table and the distance between the patient's head and the lateral film changer is 4 to 5 inches. The magnification (and distortion) factors in the anteroposterior plane are in the order of approximately 10 per cent and in the lateral plane approximately 15 per cent, but this has not proved disadvantageous. Actually, the magnification delineates the small vessels more clearly. A fixed grid is used with each film changer; these grids are specially designed 8:1 focused grids. Standard 4-inch circular extension cones are employed. Highspeed screens and standard film are used.