Modern surgical outcomes following surgery for sphenoid. Meningiomas that grow from the dura mater of the sphenoid ridge are a classic subtype of the skull base meningiomas. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. Sphenoid wing meningiomas frequently invade bone, although such invasion does not represent malignancy. Get a printable copy pdf file of the complete article 2. They account for 11% to 18% of cases in large surgical series. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing.
These are called the meninges and also help to protect the brain. Sphenoid wing meningiomas can involve the dura of the greater and lesser wings of the sphenoid, the anterior clinoid process, the sphenoorbital bone, and the. Sphenoid wing meningiomas, or ridge meningiomas, are the most. Sphenoorbital meningioma, also known as meningioma en plaque of the sphenoid wing, usually arises from the lesser wing of the sphenoid bone, is. Congenital skull anomaly with multiple brain stones and. The aim of the study is to shed light on the management of sphenoid wing meningioma, study the outcome of microsurgical resection and factors affecting its resectability. Lesions confined to the sphenoid ridge europe pmc article. Congenital skull anomaly with multiple brain stones and symptomatic meningioma of medial sphenoid wing monali chaturvedi 1, vikas janu 2, rima kumari 1, sujata chaturvedi 3, mukul kumar jain 4, deepak kumar jha 2. Methods bone involvement was compared in 12 corresponding ct and mr studies of 10 female patients with sphenoid wing meningiomas recurrence after earlier surgical treatment. Robert solomon im living a normal life for the first time.
We report a case of the clinical progression of a sphenoid wing meningioma after the placement of norplant, a subcutaneous contraceptive implant containing levonorgestrel, a progesterone agonist. Loss of smell due to compression of the nerves that run between the brain and the nose, and if the tumor grows big enough, visual symptoms can be expressed due to compression of the optic nerve. Based on this classification, meningiomas of this region can be divided into clinoidal, middle, or lateral. Sphenoid wing meningiomas still present a difficult surgical challenge especially when they are large in size and involve neurovascular structures. A more true medial sphenoid wing clinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. The designation swm refers to tumors that originate in any part of the bony crest formed by wings lesser and greater of the sphenoid bone, which represents the boundary between the anterior and the middle cranial floor. The histopathological report revealed s100 positive histiocytic proliferation with lymphophagocytosis emperipolesis characteristic of the rosaidorfman disease. Hyperostosing meningioma of pterion clay model as aid in surgical excision without bone flap. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura.
Mr findings in patients with recurrent meningioma of the sphenoid wings k. Brain computed tomography and magnetic resonance examinations revealed acute cerebral infarction in the right middle cerebral artery territory and a sphenoid ridge meningioma encasing the right carotid artery terminus. Figure 322 large medial sphenoid wing meningioma a, mr appearance of a large meningioma of the right medial sphenoid wing upper panel. Sphenoid meningioma and carcinoma of caecum sachin et al. It indents the medial aspect of the left temporal lobe and left lateral aspect of the pons and encroaches upon the left inferior orbital fissure resulting in mild left proptosis. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. Pedicled pericranial grafts for the repair of dural tears in the anterior fossa of the skull. Contrast ct of the brain showed enhancing broadbased extraaxial lesion adjacent to right greater sphenoid wing slightly compressing optic chiasm with hypervascularity and hyperostosis of bone representing a meningioma.
Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist contraceptive implant. The surgical treatment of hyperostosing meningiomas of the sphenoid wing. This requires extensive drilling of the invaded bone and extensive excision of the involved dura. Four of these had histologically confirmed meningiomatous infiltration of. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Predictors of visual outcome following surgical resection of.
Medial sphenoid wing meningioma the neurosurgical atlas. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Meningiomas arising in the sphenoid region are frequently encountered in neurosurgical practice. A previously healthy 52yearold man presented to the emergency room with acute onset left hemiparesis and dysarthria. Total surgical resection is difficult and therefore these tumors have high recurrence rates. Full text full text is available as a scanned copy of the original print version. Rosaidorfman disease mimicking a sphenoid wing meningioma. Brain ct showed an enhancing mass consistent with a right sided sphenoid wing meningioma figure a. Modern surgical outcomes following surgery for sphenoid wing.
Objective medial sphenoid wing meningiomas swms are relatively common. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. Current approach to meningiomas of the medial sphenoid wing. Medial sphenoid wing meningioma the neurosurgical atlas, by. We conducted a literature search using the pubmed database to compare data for endoscopic and microsurgical techniques in the literature. This portion of the dura mater is actually covering the lesser wing of the sphenoid bone from the anterior clinoid process acp to the pterion. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report radek fric, 1 john k. Right pterional craniotomy was performed and a tumour located under and adherent to the overlying dura was identified. Axial t1 and t2 weighted mri showed an extraaxial mass, overlying right greater sphenoid wing figure 1. Sphenoid wing en plaque meningioma development following craniopharyngioma surgery and radiotherapy. Sphenoid wing meningioma is a common entity in females worldwide. The tumor has filled the area where the temporal lobe normally lies.
Association of morbidity with extent of resection and. Meningiomas may also become clinically apparent due to mass effect depending on their location. Total removal with a prospect for cure and visual preservation should be the goal of treatment. En plaque meningiomas of the sphenoid wing were excluded from the study because they mostly extend along the entire sphenoid wing and do not have a delimited area of dural attachment. Meningiomas are presumed to account for 15% of brain tumours and are the most common tumours of the sphenoid wing 21, 22. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. A medial sphenoid wing meningioma with minimal medial extension is shown upper images. It extended laterally to the frontotemporal convexity with a broad dural attachment, giving the appearance of an en plaque meningioma. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. Jul 09, 20 sphenoid wing en plaque meningiomas are also designated by sphenoorbital meningiomas,18 hyperostosing meningiomas of the sphenoid wing, pterional meningioma en plaque, and invading meningioma of the sphenoid ridge. Madisons epilepsy cure meet the doctor video series complete. Sphenoid wing en plaque meningioma development following. Management of boneinvasive, hyperostotic sphenoid wing.
Original article surgical management of sphenoid wing. The rates of optic canal invasion medial 50% vs middle 5% vs lateral 0%. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. Pdf rosaidorfman disease mimicking a sphenoid wing meningioma. An aggressive sphenoid wing meningioma causing foster. The tumor was first described in 1910 by frotscher and becker as an autopsy finding in a 72yearold man. They are considered to be benign tumours arising from cap cells located in clusters around the arachnoid granulations that exist in relation to neural structures and their foramen. Purpose we used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. A total of 56 patients underwent microsurgical resection for sphenoid wing meningioma during this period. Pdf rosaidorfman disease mimicking a sphenoid wing. Radiationinduced after three decades amol raheja, guru dutta satyarthee department of neurosurgery and gamma knife, all india institute of.
Meyers is snis 2010 annual meeting chairman announcing dr. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. Pubmed pubmed citation articles by arthur ecker similar articles in pubmed. This portion of the dura mater is actually covering the lesser wing of the sphenoid bone from the anterior clinoid process acp to the pterion epidemiology. Askep meningioma pdf sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Middle and medial sphenoid wing meningioma with brain invasion this 53year old woman presented with severe headaches and blurred vision in the right eye for the last 6 months. Links to pubmed are also available for selected references. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Congenital skull anomaly with multiple brain stones and symptomatic meningioma of medial sphenoid wing monali chaturvedi 1, vikas janu 2, rima kumari 1, sujata chaturvedi 3, mukul kumar jain 4, deepak kumar jha 2 1 department of neuroradiology, institute of human behavior and allied sciences, new delhi, india 2 department of neurosurgery, institute of human. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. At microsurgical excision, the lesion was firm and relatively avascular. A brain mri scan revealed a large cranial base lesion involving the left sphenoid wing, including the anterior clinoid process. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis. An aggressive sphenoid wing meningioma causing foster kennedy.
Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary. Imaging characteristics of temporal bone meningioma have not been previously reported in the literature. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Foster kennedy syndrome is a rare entity found with intracranial neoplasms. Imaging and clinical characteristics of temporal bone. Meningioma brain tumor, meningioma treatment options mayfield. Mri revealed an enhancing, duralbased, left lateral sphenoid wing. Many of the histological variants are also discussed separately. First described in 1911, the foster kennedy syndrome also known as gowerspatonkennedy syndrome originates from a retrobulbar compressive optic neuropathy commonly caused by sphenoid wing meningioma, frontal lobe glioma, optic neuroglioma, olfactory glioma, chiasmal glioma, and craniopharyngioma. Sphenoid wing en plaque meningiomas are also designated by sphenoorbital meningiomas,18 hyperostosing meningiomas of the sphenoid wing, pterional meningioma en plaque, and invading meningioma of the sphenoid ridge. In the classical neurosurgical literature, anterior clinoidal meningiomas have not been separated from medial sphenoid wing or inner sphenoid wing meningiomas 1,2. A giant solid cavernous hemangioma mimicking sphenoid wing.
The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr. Imaging and clinical characteristics of temporal bone meningioma. Among 108 medial sphenoid wing meningiomas, there were 81 women 75% and 27 men 25%. Inside the skull, and covering the brain, are 3 thin sheets of body tissue. Normal pressure hydrocephalus secondary to intracranial mass. Sphenoid wing meningioma progression after placement of a. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement. Abstracta causal relationship between sex steroids and meningioma proliferation has long been suspected. Left sphenoidal wing extra axial durally based mass. Sphenoid wing meningiomas exhibit a very high incidence of hyperostosis, which can be observed in up to 90% of cases. Mr imaging showed a large sphenoid wing tumor invading the brain with the involvement of lateral wall of the cavernous sinus figure 2.
However, accumulating anatomical knowledge and clinical experience has shown that anterior clinoidal. Benign sphenoid wing meningioma presenting with an. In some cases, deletions involving chromosome 22 are involved. Hald, 2, 3 and ellenann antal 4 1 department of neurosurgery, oslo university hospital rikshospitalet, oslo, norway. Andersons spasticity program has grown by leaps and bounds aneurysm aneurysm clipping aneurism anuerysm angevine brings spinal deformity expertise to aans 20 ankylosing spondylitis ann riley finck wins columbias clinical nursing excellence award announcement. Postoperative radiation therapy is indicated in cases with residual tumor in these locations. The surgery of swms is complicated and difficult due to their invasion of bone and proximity to main arteries and nerves.
The presenting features, operative details and complications were documented. This article is a general discussion of meningioma focusing on typical primary intradural meningiomas and the imaging findings of intracranial disease. Our initial diagnosis was a sphenoid wing meningioma but. Given her history of known sphenoid wing meningioma, neuroimaging with mri was obtained. Large and giant medial sphenoid wing meningiomas involving vascular structures. Sphenoid wing hyperostosis has been reported as high as 42% of all meningiomas in this area. Normal pressure hydrocephalus secondary to intracranial. No hyperostosis or infiltration of the underlying bone was evident. The authors report a rare case of an osteolytic mep extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle. Meningioma im scared to watch and wait mayo clinic connect. This case report presents the case of a sphenoid wing meningioma in. Intracranial extracerebral follicular lymphoma mimicking a. Meningiomas are much more common in females, and are more common after 50 years of age. If the inline pdf is not rendering correctly, you can download the pdf file here.
Anterior clinoidal meningiomas arise from the meningeal covering of the anterior clinoid process. Surgical management of sphenoid wing meningiomas clinical gate. Reconstruction after resection of sphenoid wing meningiomas. A total of 180 patients with a sphenoid wing meningioma were operated during a period of 5 years, with 78 patients having tumors of the medial sphenoid ridge, 11 having optic canaloptic sheath meningiomas, seven with primary cs meningiomas, and the remaining 84 having either a lateral sphenoid ridge or an en plaque tumor. This is the name given to the protective lining of the brain and spinal cord. Sphenoorbital meningioma, also known as meningioma en plaque of the sphenoid wing, usually arises from the lesser wing of the sphenoid bone, is often associated with bony hyperostosis, and may. Sphenoid wing sw en plaque meningioma epm is a subgroup of meningiomas defined by its specific character presenting. Stamca bypass following sphenoid wing meningioma resection. Sphenoid ridge meningioma presenting as acute cerebral. Sphenoid ridge meningiomas represent approximately 20% of supratentorial meningiomas, among which less than half arise from the medial ridge of the sphenoid. Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. Compared with other meningiomas, swms possess higher mortality, disability rate and recurrence rate. Sphenoid wing meningiomas swms account for approximately 1520% of intracranial meningiomas. Lateral orbitotomy approach for removing hyperostosing en.
Current approach to meningiomas of the medial sphenoid. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. An osteolytic meningioma en plaque of the sphenoid ridge ncbi. Pdf a 40yearold male presented with a single generalized tonicclonic seizure.