International Journal of Osteoarchaeology, Vol. 5: 144-150 (1995)

Signs of Meningiomas in a Skull of the Mexican Colonial Period DOMINGO CAMPILLO' AND MAR~A-ELENA SALAS-CUESTA** 'Archeological Museum; Autonomous University and ex-neurosurgeon of the Q.S.A. in Barcelona, Spain; and 2National Institute of Anthropology and History (1NAH)lDirector of Physical Anthropology (DAF), Mexico, D.F: *(In alphabetic order)

ABSTRACT The skull of a native Mexican from the colonial period is studied. The skull has a nasal trauma, dental pathology and two osteogenic lesions, one situated at the left wing of the sphenoid bone and the other in the infrainion occipital squamous bone, between the left mastoid process and the left occipital condyle. That involving the sphenoid occludes the optic nerve foramen and is evident through the orbit and at pterion. These osteogenic lesions are considered to be secondary to the soft tissue tumour mass, which, at the level of its implantation area, is usually present in meningiomas.

Keywords: turnour; meningioma; meningiomatosis; trauma; Mexico.

Introduction

There is no doubt that the study of skeletal remains from archaeological sites has provided us with invaluable information, taking into account different points of view, that has enabled us to reconstruct certain aspects of the populations that lived in the past. For example, osteopathologic analyses have enabled us to learn something of the antiquity, distribution and frequency of the diseases from which these groups suffered.

The excavation of the present site was performed in 1988 by the Director of Physical Anthropology (DAF) of the National Institute of Anthropology and History (INAH), in the Plaza del Templo de la Santa Cruz y Soledad de Nuestra Seiiora, in the City of Mexico.

The church is located in the first block of the City of Mexico within the area corresponding to the Venusian0 Carranza Delegaci6n. To the north it meets with San Lizaro Square, to the east with Puente del Rosario Street, to the south with the Soledad Street block and to the west with Santa Escuela Street. It would seem that this building was founded in 1576, as the neighbours of this place raised a hermitage for preaching the Christian doctrine, baptizing it with the name of

ccc 1047-482x/95/020 144-07 0 1995 by John Wiley Sons, Ltd

'Santa Cruz y Soledad de Nuestra Seiiora'. At first, this church depended ecclesiastically on the San Pablo Parish and was part of the Franciscan Order; later it was handed over to the Augustines who extended the building and preserved it until 1756 when it was secularized.

In 1754 Father Gregorio Pirez Cancio took possession of the church, but it was not until 1774 that this clergyman proposed the construction of a new parish, which was finished by about 1 8 10, as is registered in the stonework book to be found in the archives of the said church.' This parish was said to be located outside the city walls and was inhabited basically by the native population, who had very few resources. In accordance with the ecclesiastic orders, the native people were generally buried in this parish.3

The skeletal collection is made up of 150 human burials, of which 1 1 3 were primary burials and 37 were ossuary burials. The latter were found in situ and were well demarcated, and comprised skulls, jaws and bones of the postcranial skeleton.2

Description of the skull

The skull under examination in this analysis is in excellent condition and corresponds to number

Received 8 June 1994 Accepted 2 6 October 1994

Meningiomas in a Mexican Colonial Period Skull 145

L.P. 401

I !

5 Cm.

EXOSTOSIS

0 TUMOUR

Figure 1. Craniograms showing the location of diverse lesions. N, nasal fracture, V and V', areas with clusters of small vascular orifices.

250 of the XIX ossuary group, and belonged to a male aged between 35 and 40 years at the time of death. It has mongoloid morphologic features, suggesting that it belonged to a native who lived in this area during the colonial period.

External pathology

As seen from a frontal view (Figures 1-4) one observes how the afflicted male suffered from an

intense traumatic lesion that involved the bones of the nose, the base of the anterior nasal septum, the vomer and conchae, of which the right concha is thicker. It is possible that this trauma was caused by a blunt, cutting force in a downward direction.

There is an ante-mortem loss of MI, M2, PM 1 and PM2 on the right side, and of C, PMI and PM2 on the left. The remaining teeth were lost post-mortem. The spaces occupied on both sides by the molar teeth show signs of having suffered from infectious diseases of a dental origin.

146 D. Cumpillo and M.-E. Salas-Cuesta

Figure 2. Tuberous exostosis within the left orbit. N. nasal fracture; S, three supraorbital orifices, probably related to an increase in blood supply, as usually occurs in meningiomas.

Osteoarthritic alterations also can be seen in both mandibular Fossae.

In the orbital cavity and in the left pterygoid region (Figures 1-4) hyperostotic alterations can be seen. O n the vault, two areas are observed that have an increase in the vascular foramina, one beside the lateral crest of the frontal bone the other parasagittally at the posterior parietal bone close to the left lambdoid suture.

Palaeopathologic study

Independently of the traumatic alterations mentioned in the preceding section, we centre our study on the hyperostotic lesions mentioned and on the areas with a hypervascular appearance, referring to them separately and correlating them in order to give our diagnostic opinion. All these lesions affect the left side and their positions can be seen in Figure 1.

Orbital-pteric lesion

Figure 3. Left lateral view of the lesions: N, nasal fracture; E, extosis at the pterygoid face of the greater wing of the sphenoid; V, area with clusters of small vascular orifices.

When the skull is examined face on, of the nasal bone fractures already described

Meninjiornas in a Mexican Colonial Period Skull 147

Figure 4. Lateral view of the left half of the skull showing the alveolar deterioration (A); the nasal fracture (N); exostosis of the pterion region (E); clusters of orifices of a frontal vascular origin (V); situation of the occipital exostosis (0).

Figure 5. Detail of the left occipital exostosis (0), situated between the occipital condyle, the mastoid process and the jugular foramen.

(Figures 1 (N) and 2(N)), one can see a marked greater in size. It seems obvious that the exostosis is hyperostotic reaction situated within the left orbit, associated with a hypervascularization. The lesion that respects the sphenoidal fissure but occludes hardly involves the orbital face of the frontal bone, the optic foramen. The thickness of this exostosis is being limited to the whole of the orbital surface of so marked that the orbital cavity loses its pyramidal the sphenoid wings. When we examine the shape. The exostosis consists of spongy bone, endocranium using a tilted mirror with formedby small alveoli with several orifices slightly autoillumination we also observe a hyperostotic

148 D. Campillo and M.-E. Salas-Cwesta

reaction at the posterior face of the sphenoid wings. External examination confirms that the external face of the greater wing of the sphenoid bone, at the pteric region, also shows hyperostotic reaction (Figures 3 and 4). In summary, these exostoses exclusively involve the left wings of the sphenoid bone and only within the orbit are the frontal and malar bones slightly affected at their orbital faces.

Occipital lesion

At the left portion of the infrainion squamous occipital bone between the condyle and the jugular foramen, one can observe a hyperostotic reaction that is less intense but similar to that of the pteric region (Figure 5) . At the endocranium there is also a hyperostotic reaction. The morphological similarity between these and the other lesions seems to suggest the same aetiology.

Mu2tiperforated area Of

frontal bone

Almost in contact and below the lateral crest of the frontal bone, one can observe a group of small more-or-less circular orifices, of a vascular appearance (Figures I(V), 3(V) and 4(V)).

left lateral jace Of the Figure 6. Anteroposterior X-ray of the skull, showing the interior of the left orbit, the intense exostotic reaction at the sphenoid wings (arrows).

alterations are visible radiographically in the occipital region owing to a superimposed image.

Left parietal parasagittal multiperforated area

This region, which is similar to the former lesion, is smaller in size and is situated close to the lambdoid suture (Figure I ( V ) ) .

x-ray study

The anteroposterior X-ray (Figure 6) reveals intense thickening of both left wings of the sphenoid bone, with greater exostotic density at the outer two thirds. The optic foramen is not visible.

Thex-rays taken with Hirtz projection (Figure 7) enables us to appreciate the more marked thickness of the greaterwingup to the pterion. No appreciable

Interpretation of the lesions

By the morphology, situation and radiographic appearance of the orbital-pteric lesion we consider it almost certainly to correspond to the exostotic reaction of a meningioma involving the left wings of the sphenoid, with expansion of the probably voluminous soft tumour mass towards the orbit and middle fossa (Figure I(E)).

Clinically, it is known that some tumours in this region give rise to dense bone formation, which at the pterion can reach a thickness greater than 2@-30mm, whilst the soft tumour mass in such cases is usually only slight. However, in these cases the bone is of a porous nature and is

Mminjiomas in a Mexican Colonial Period Skull 149

Figure 7. X-ray using Hirtz projection, that enables one to appreciate the marked exostotic reaction of the left sphenoid wings (e) as well as more moderate exostosis at the occipital bone (0).

associated with voluminous soft tumours which, in our clinical experience, frequently involve psammomas (12.7 per cent of the cases), these tumours being responsible for 60 per cent of the bony reactions. In our opinion this present archeological case corresponds to a typical tumour involving the sphenoid wings.

The occipital lesion, because of the morphology of its hyperostosis, most probably corresponds to another meningioma, in this case in an infratentorial situation, with a much less intense osteogenic reaction, although the soft tumour mass could have had a considerable volume.

With regard to the other lesions (the perforated areas), we do not believe it probable that they correspond to other meningiomas, but rather to vascular bone alterations, although that related to the frontal bone, situated close to the pterion, could have been related to the hypervascularization associated with meningiomas, the blood supply arising from the external carotid artery via the

middle meningeal arteries. Possibly, the presence of three left supraorbital orifices (Figure 2.(S)), not occurring at the right side, could be related to tumour hypervascularization.

Conclusions

( i ) In our opinion, the nasal trauma bears no relationship to the neoplasm.

(i i ) The dental pathology is a habitual finding during this period.

( i i i ) The two proposed osteogenic neoplasms, if caused by meningiomas, were almost certainly the cause of death in the patient.

(iv) The clinical picture must have presented with marked neurological symptoms, with a syndrome of cranial hypertension, both due to the volume of the tumour mass during the final stages of disease, as well as to problems with the flow of cerebrospinal fluid. There must have been internal hydrocephaly due to compression of the anterior portion of the third ventricle or compression of the fourth ventricle and/or distortion of the cerebral aqueduct. Occlusion of the optical foramen must have led to blindness in the left eye, associated with exophthalmus and, if the individual were right-handed, to mental alterations and language disorders.

(v) The probable presence of twomeningiomas, in a relatively young male, lead us to suggest that perhaps he suffered from a truemeningiomatosis with multiple tumours.

Comments on the prevalence of meningiomas detected in palaeopathology

The first time we approached the subject of meningiomas we presented our first two cases and were able to refer to only five other cases of meningeal tumours described in the literature.6 By 1990 we had diagnosed five meningiomas, three from the prehistoric period and two from medieval times, 'c8 and more recently we have encountered only one other published case of a voluminous osteolytic-osteogenic meningioma in

150 D. Camgillo and M.-E. Salas-Cuesta

en el Area Maya, 1981; IV: 411-418. Chiapas Mixico.

3 . Pescador, J. 1. De Bautizados a Fieles Difuntos: Familia y mentalidad de una parroquia urbana: Santa Catalina de Mixico.

4. laen, E., Bautista, M. y Hernindez, E. Algunos ejemplos de traumatismos craneofaciales. Estudios de Antrop. Biol. U N M I N A H [Mbico, 1990; V: 57- 70.

5 . Krogman, W. M. and Iscan, M. T. The Human Skeleton in Forensic Medicine. Springfield, IL: C. Thomas, 1986.

6. Campillo, D. Paleopatolgia del crineo en Cataluiia, Valencia y Baleares. Barcelona: Montblanc-Martin, 1977.

7. Campillo, D. Problemas diagnbsticos de 10s meningiomas en paleopatolog’a. Dynomis (Grunada), 4: 115-149.

8. Campillo, D. The possibility of diagnosing meningiomas in palaeopathology. International Journal of Osteoarcbaeofogy, 1991; 4: 225-230.

9. Ortner, D. J . and Putschar, W. G. J . Identification of Pathological Conditions in Human Skeletal Remains. Washington, DC: Smithsonian Institution Press, 1985.

10 Campillo, D. La enfermedad en la prehistoria. Barcelona: Salvat, 1983.

1 I . Campillo, D. Paleopatologi’a. Los primeros verstigios de la enfermedad. 1. Barcelona: Fundaci6 Uriach, 1993.

12. Anderson, T. A medieval example of meningiomatous hyperostosis. Journal of Paleopathology, 1992; 4 3 ) : 141-154.

13. Taveras, J. M. and Wood, E. H. Diagnostic Neuroradiology. Baltimore: Williams & Wilkins, 1964.

a Singhalese male.9 This case was very similar to that of another individual from the beginning of this century that we described in 1983 and 1993,10,11 but was not included in their study because it was not antique.

In our opinion the case in question in this study is interesting because it involves two tumours, one of which was situated in the sphenoid wings. In the palaeopathological literature consulted we have found one similar case located in the sphenoid,I2 although less typical as it invades the frontal bone and cheek bone, an infrequent event in tumours of the sphenoid. In clinical statistics tumours of the lesser wing, associated or not with the greater wing, occupy a third place in frequency,’3 the mean incidence of multiple meningiomas being only 2 per cent. We also note that the frequency is low prior to 40 years of age and males are less often affected than females, the proportion being 1 to 3 according to the statistics. In our work, the proportion is I to 2.4.’

References

I . Pirez-Cancio, G. Libro de fibrica del templo de la Santa Cruz y Soledad de Nuestra Seiiora. Afios 1773 a 1784. Transcripci6n pr6logo y notas de G. Obregbn, MPxico: National Institute of Anthropology and History, 1 970.

2. Jiminez, L., Romero, J. and Saucedo, A. Las exploraciones en el templo de la Santa Cruz y Soledad de Nuestra Seiiora, Mixico, D. F. lnforme Preliminar. XVll Mesa Redonda de la SOC. Mixicana de Antrop. Investigaciones recientes