Evidence for ancient meningiomas and a probable case from Medieval Tarbat, Scotland.

We report the case of a probable meningioma in a cranium excavated from the Medieval site of Portmahomack on the Tarbat Peninsula in Scotland (Carver, 2008). Stratigraphic evidence enabled dating of the remains to a post-Pictish and pre-Reformation date. Meningiomas usually arise from the arachnoid membrane of the meninges (Yamazaki et al., 2001) and now represent approximately 20% of all primary intracranial tumours (Yener et al., 2009). They can result in hyperostosis of adjacent bone, osteolytic reactions, or both. We review the evidence for ancient meningiomas and describe a differential diagnosis of the pathology from the Tarbat cranium, including vascular and osteoid lesions, intracerebral malignancies, metastases and other benign lesions. The cranium that we present is from an adult male, and has a frontoparietal lesion approximately 3cm in diameter, which is characterised by bone growth and remodelling of the outer table, and endocranial bone destruction. Supporting photographic and radiological evidence is presented. We conclude that a diagnosis of meningioma is most likely in this case, and may represent the rarer primary extradural meningioma.

The attitudes of relatives to autopsy: a misconception.

AIM: Hospital autopsy rates have been falling steadily over recent decades. One factor that has been implicated in this decline is the perception that the general public views postmortem examinations unfavourably and that this often makes clinicians reluctant to discuss autopsy with families and seek their consent. The aim of this study was to test this assumption. OBJECTIVES/METHODS: In the division of lymphoid malignancies at St Bartholomew's Hospital, we suggested autopsy and discussed it in depth with the families of all the patients who died in hospital in an 8-month period in order to assess whether the autopsy rate could be increased by improving the approach to the relatives. RESULTS: Consent for a postmortem examination was requested in 18 of 23 cases and granted in 16 cases, giving a consent rate of 89%, and an overall rate of autopsy of 69.5%. CONCLUSION: The attitude of the general public is positive overall, and translates into high autopsy rates when the value of the examination is presented honestly and the details of the procedure are adequately explained.