Necrotizing neurosarcoidosis of the cranial base resembling. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. 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. Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist. Left sphenoidal wing extra axial durally based mass. Meningiomas, meningioma brain tumor mayfield clinic. The tumour is typically slow growing, of limited thickness and has a flat or slightly nodular shape. Dec 18, 2019 the bony expansion and groundglass appearance of sphenoid wing meningioma complicates differentiation from fibrous dysplasia. The aim of the study is to shed light on the management of sphenoid wing meningioma, study the outcome of. Prior to the diagnosis of sphenoid wing meningioma, the patient reported the follow ing symptoms to her physician.
Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from january 2012 to june 20. The patient underwent a gadoliniumenhanced brain mri, which showed a large left sphenoid wing meningioma with surrounding edema compressing the basal ganglia. Askep meningioma pdf sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Cardiac evaluation revealed a normal left ventricular ejection fraction without ischemic, structural, or valvular heart disease. It extended laterally to the frontotemporal convexity with a broad dural attachment, giving the appearance of an en plaque meningioma. These tumors do not arise from the brain itself but instead grow inward from the meninges displacing the brain or spinal cord. There are several cases of postoperative visual recovery in patients with longterm decreased vision due to innerthird sphenoid wing meningioma, however, we found no reports of patients who improved from longterm blindness. Meningioma im scared to watch and wait mayo clinic connect. Sep 30, 2018 principles for diagnosis and management of lateral and middle sphenoid wing meningiomas, including indications for surgical intervention, relevant operative anatomy, and technical principles of the cranial approach. The bony expansion and groundglass appearance of sphenoid wing meningioma complicates differentiation from fibrous dysplasia.
Diverse imaging appearances and locations of meningioma. 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. Sphenoid wing meningioma with rheumatic heart disease challenges and management case report. Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary. Meningioma tumours are more common in older people and in women, although they may occur in men and in young people too. This is sphenoid wing meningioma by surgical neurology international on vimeo, the home for high quality videos and the people who love them. References to any names, marks, products, or services of third parties or hypertext links to third. The differential diagnosis for sphenoid wing meningioma includes other types of tumors such as optic nerve sheath meningioma, cranial osteosarcoma, metastases, and also sarcoidosis. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. Meningioma en plaque is most commonly seen in the sphenoid wing, although they have been described in a number of locations. This case demonstrates strong radiological features in keeping with a sphenoid wing meningioma involving the region of the anterior clinoid, adjacent medial sphenoid wing, superior orbital fissure, and cavernous sinus. Sphenoidal meningiomas constitute 18% of intracranial masses. Amirjamshidi a, abbasioun k, amiri rs, ardalan a, ramak hashemi sm. Endoscopic transnasal orbital decompression for visual.
Total surgical resection is difficult and therefore. The rate of recurrence for medial sphenoid wing meningiomas is reported as. Primary intraosseous meningioma of the right greater. It exerts a compressive effect on the adjacent skull foramina as compression on the optic nerve. Meningiomas are common tumors comprising over 30% of all primary central nervous system cns tumors. Download as pdf print show related cases notify admin. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Meningiomas of the skull base pdf free download ebook description meningiomas, the second most frequent of intracranial tumors, are characterized by a protean range of possible locations and appearances, due to their origin from the extensive and intricately formed meninges. The left sphenoid wing meningioma, on cemri, is seen in the intraoperative photograph.
The gold standard approach for the majority of tumors is the. 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. Management of intracranial meningiomas using keyhole techniques. Xray showing density and destruction of lateral wall and floor of left antrum, with increased radioopacity and erosion of left sphenoid wing. En plaque meningiomas with hyperostosis of the sphenoid bone, which often invade large areas. Management of sphenoid wing meningioma poses a big. Original article surgical management of sphenoid wing. Sphenoid wing meningioma presenting as sudden sensorineural.
Olfactory groove and sphenoid wing meningiomas meningiomas are typically benign, slowgrowing tumors that arise from the meninges. Hyperostotic sphenoid wing meningioma en plaque romanian. Sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Anterior clinoidal meningiomas arise from the meningeal covering of the anterior clinoid process. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing and eisenhardt. No hyperostosis or infiltration of the underlying bone was evident. Meningiomas may originate in unexpected locations such as the orbit, paranasal sinus, or ventricles or be entirely intraosseous within the calvaria. Here, the authors report a case of sphenoid ridge meningioma presenting with acute cerebral infarction caused by middle cerebral artery mca compression. A brain mri scan revealed a large cranial base lesion involving the left sphenoid wing, including the anterior clinoid process. Medial sphenoid wing meningioma the neurosurgical atlas. Any information contained in this pdf file is automatically generated from digital material submitted to epos by third parties in the form of scientific presentations. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement. Objective medial sphenoid wing meningiomas swms are relatively common tumors that are associated with significant morbidity and mortality, primarily from.
About 20% of all meningiomas are sphenoid wing meningiomas. Tuberculum sellae meningiomas tsms are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. Our main outcome measures were aesthetic evaluation by physicians as well as analysis of tumor control using computed tomographic ct scans, survival time, and complications. Sphenoid wing meningioma presenting as cognitive impairment. Histologicalsubtypes and anatomical location correlated in meningeal brain tumors meningiomas. Location of hyperstosis according to frequency lesser wing of the sphenoid bone the greater wing of the sphenoid the roof of the orbit the inferior orbital fissure the infratemporal fossa the orbital rim 10. Cavernous sinus gamma knife optic canal sphenoid bone dural attachment. Mr findings in patients with recurrent meningioma of the sphenoid wings k. Sphenoid wing meningiomas could pose a unique challenge due to the difficulty associated with gross total resection, particularly in cases of cavernous sinus infiltration. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas, characterized by a carpetlike usually small soft tissue component which. Improvement of longterm blindness caused by compression from. While most meningioma subtypes commonly present with headache, altered.
Histologicalsubtypes and anatomical location correlated. 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. Description of surgical strategy and analysis of findings in a series of 88 patients with longterm follow up. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Approximately 1520% of all meningiomas arise from the sphenoid wing, with about half of these arising from the medial portion of the wing.
Meningioma im scared to watch and wait mayo clinic. However, accumulating anatomical knowledge and clinical experience has shown that anterior clinoidal meningiomas have. Oct 10, 2016 the rate of recurrence for medial sphenoid wing meningiomas is reported as being one of the highest amongst intracranial meningiomas. Pronounced limb weakness prompted neurological consultation. Hormonedependent shrinkage of a sphenoid wing meningioma. Pdf sphenoid wing meningioma presenting as cognitive. Parafalcine meningioma likely arising from sphenoid wing. 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.
Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region from the temporal fossa. Reconstruction after resection of sphenoid wing meningiomas. A 30yearold female patient with primary intraosseous meningioma of the right greater sphenoid wing. In our large experience with sphenoid wing meningiomas at the university of miami, we have never used preoperative embolization and have. Nov 11, 2012 neurosurgical resection of sphenoid wing meningiomas with microsurgical technique. To exclude a vascular pathology as the cause of her symptoms, standard cranial mri without contrast agent. The tumor has filled the area where the temporal lobe normally lies. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. T1 and t2weighted and timeofflight angiography was performed. In the classical neurosurgical literature, anterior clinoidal meningiomas have not been separated from medial sphenoid wing or inner sphenoid wing meningiomas 1,2.
A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Meningiomas in pregnancy neurosurgery oxford academic. Cureus management of intracranial meningiomas using. Lateral orbitotomy approach for removing hyperostosing en plaque sphenoid wing meningiomas. Typical, atypical, and misleading features in meningioma. 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. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. Pdf sphenoid wing meningioma presenting as cognitive impairment. As cushing and eisenhardt 5 put it in their monography published in 1938. There were 108 medial sphenoid wing meningiomas of globoid shape. Among 108 medial sphenoid wing meningiomas, there were 81 women 75% and 27 men 25%.
A 57yearold man presented with recurrent episodes of dizziness, weakness of legs, and presyncope. Sinq 2016 states that sphenoid wing meningiomas arise in the bone. Meningiomas are presumed to account for 15% of brain tumours and are the most common. Avid homogenous contrast enhancement of the sphenoid wing mass with significant right proptosis, with the sphenoid wing mass extending into the extraconal space and edema in the inferior temporal lobe. The rate of recurrence for medial sphenoid wing meningiomas is. Lateral sphenoid wing meningiomas without bone invasion. However, acute cerebral infarction, resulting from intracranial arterial occlusion or obstruction related to meningioma is extremely rare 4, 9, 15. Olfactory groove and sphenoid wing meningiomas columbia. Sphenoid wing meningiomas still present a difficult surgical challenge especially when they are large in size and involve neurovascular structures. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. The lateral transzygomatic approach to the sphenoid wing can be performed safely with minimal morbidity and facilitates complete resection of the tumor. The technique and results for endoscopic transnasal decompression of the orbital apex is presented. Predictors of visual outcome following surgical resection of.
They account for approximately 20% of supratentorial meningiomas. Lateral transzygomatic approach to sphenoid wing meningiomas. Olfactory groove and sphenoid wing meningiomas atlantic. Keyhole craniotomies are increasingly being used for lesions of the skull base. The meninges are a protective membrane surrounding the brain and spinal cord. Large and giant medial sphenoid wing meningiomas involving vascular structures. Meningioma tumor locations brain science foundation. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura.
Meningiomas vary in their symptoms and appropriate treatment options depending on their location. Lateral orbitotomy approach for removing hyperostosing en. The sphenoid wing meningiomas are the most common of the skull base and. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. The surgical treatment of hyperostosing meningiomas of the sphenoid wing. Get a printable copy pdf file of the complete article 2. Sharply demarcating frontal from middle basilar fossa, a bony ridge curves outward on a horizontal plane from the anterior clinoidal process toward the lateral aspect of the cranial chamber. However, given their surgical similarities with nonskull base meningiomas nsbms, we hypothesized that lateral sphenoid wing meningiomas lswms without. This term was given by cushing to differentiate them from the commonest form, also called meningioma en masse. En plaque meningiomas with hyperostosis of the sphenoid bone, which often invade large areas of the sphenoid bone, the optic. En plaque sphenoid wing meningioma is morphological unique in comparison with. The electrocardiogram showed a sinus bradycardia and recurrent sinus pauses. Sphenoid wing meningiomas are a heterogeneous group of tumors with variable surgical risks and prognosis. The authors retrospectively analyzed 78 consecutive patients with the diagnosis of medial sphenoid wing meningioma who were operated in our department from january 2008 to december 2012.
A more true medial sphenoid wing clinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Mri axial t1fatsaturation postcontrast showing right greater sphenoid wing lesion and adjacent dural enhancement arrow. Complete removal at an early stage is the best prognostic factor in treating sphenoid wing meningioma. Hemiparkinsonism secondary to sphenoid wing meningioma. Some meningiomas can cause problems despite their benign nature. Surgical management of giant sphenoid wing meningiomas. Pdf hyperostotic sphenoid wing meningioma en plaque. The latest cancer research uk statistics show that between a quarter and a third 2533% of all primary brain tumours in adults is a meningioma.
See related sections symptoms and diagnosis and treatments the tumors location is most often included in its description. Following the physical exam, the diagnosis is confirmed with neuroimaging. Meningiomas are much more common in females, and are more common after 50 years of age. The typical meningioma is a homogeneous, hemispheric, markedly enhancing extraaxial mass located over the cerebral convexity, in the parasagittal region, or arising from the sphenoid wing. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. A medial sphenoid wing meningioma with minimal medial extension is shown upper images. Meyers is snis 2010 annual meeting chairman announcing dr. Below is a listing of locations where meningiomas are found. Sphenoid wing meningiomas are generally considered as skull base meningiomas sbms. Details of the image sphenoid wing meningioma modality. Improvement of longterm blindness caused by compression. Resection of a hyperostotic lateral sphenoid wing meningioma with intraorbital extension sphenoorbital meningioma approximately 15 to 20% of all meningiomas arise from the sphenoid wing, with half of them emanating from the lateral and middle portion of this bone. Original article surgical management of sphenoid wing meningiomas. However, the discussion section states a sphenoid wing meningioma arises from arachnoid cap cells somewhere along the sphenoid wing, however, it does not actually state that the meningioma arises in the bone.
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