Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary. Given her history of known sphenoid wing meningioma, neuroimaging with mri was obtained. We conducted a literature search using the pubmed database to compare data for endoscopic and microsurgical techniques in the literature. Full text full text is available as a scanned copy of the original print version. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. An aggressive sphenoid wing meningioma causing foster kennedy. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura. Meningioma is the most common extraaxial brain tumour in adults and frequently originates in the suprasellar, frontobasal, temporobasal, sphenoid wing, or petroclival regions. An osteolytic meningioma en plaque of the sphenoid ridge ncbi. Medial sphenoid wing meningioma the neurosurgical atlas. Association of morbidity with extent of resection and. Sphenoid wing meningiomas frequently invade bone, although such invasion does not represent malignancy.
The authors report a rare case of an osteolytic mep extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle. Left sphenoidal wing extra axial durally based mass. 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. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. Sphenoid wing meningiomas exhibit a very high incidence of hyperostosis, which can be observed in up to 90% of cases. 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. Medial sphenoid wing meningioma the neurosurgical atlas, by. 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 en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis.
Meyers is snis 2010 annual meeting chairman announcing dr. 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. Congenital skull anomaly with multiple brain stones and. 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. Total surgical resection is difficult and therefore these tumors have high recurrence rates. Stamca bypass following sphenoid wing meningioma resection. 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.
Anterior clinoidal meningiomas arise from the meningeal covering of the anterior clinoid process. Normal pressure hydrocephalus secondary to intracranial. 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. Sphenoid wing sw en plaque meningioma epm is a subgroup of meningiomas defined by its specific character presenting. A more true medial sphenoid wing clinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Management of boneinvasive, hyperostotic sphenoid wing. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report.
Pdf a 40yearold male presented with a single generalized tonicclonic seizure. Modern surgical outcomes following surgery for sphenoid. A brain mri scan revealed a large cranial base lesion involving the left sphenoid wing, including the anterior clinoid process. Normal pressure hydrocephalus secondary to intracranial mass. A giant solid cavernous hemangioma mimicking sphenoid wing. Pdf rosaidorfman disease mimicking a sphenoid wing meningioma. Sphenoid wing meningiomas still present a difficult surgical challenge especially when they are large in size and involve neurovascular structures. Meningiomas may also become clinically apparent due to mass effect depending on their location. Sphenoid wing en plaque meningioma development following. Hald, 2, 3 and ellenann antal 4 1 department of neurosurgery, oslo university hospital rikshospitalet, oslo, norway. Mr findings in patients with recurrent meningioma of the sphenoid wings k.
Original article surgical management of sphenoid wing. The surgery of swms is complicated and difficult due to their invasion of bone and proximity to main arteries and nerves. This requires extensive drilling of the invaded bone and extensive excision of the involved dura. Imaging and clinical characteristics of temporal bone.
If the inline pdf is not rendering correctly, you can download the pdf file here. Inside the skull, and covering the brain, are 3 thin sheets of body tissue. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. Our initial diagnosis was a sphenoid wing meningioma but. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. Four of these had histologically confirmed meningiomatous infiltration of. Lesions confined to the sphenoid ridge europe pmc article. In the classical neurosurgical literature, anterior clinoidal meningiomas have not been separated from medial sphenoid wing or inner sphenoid wing meningiomas 1,2.
The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr. A total of 56 patients underwent microsurgical resection for sphenoid wing meningioma during this period. Figure 322 large medial sphenoid wing meningioma a, mr appearance of a large meningioma of the right medial sphenoid wing upper panel. Among 108 medial sphenoid wing meningiomas, there were 81 women 75% and 27 men 25%. Current approach to meningiomas of the medial sphenoid wing. Sphenoid meningioma and carcinoma of caecum sachin et al. The histopathological report revealed s100 positive histiocytic proliferation with lymphophagocytosis emperipolesis characteristic of the rosaidorfman disease. Imaging characteristics of temporal bone meningioma have not been previously reported in the literature. Meningiomas are much more common in females, and are more common after 50 years of age. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement. 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 meningioma progression after placement of a subcutaneous progesterone agonist contraceptive implant. Axial t1 and t2 weighted mri showed an extraaxial mass, overlying right greater sphenoid wing figure 1. Meningioma im scared to watch and wait mayo clinic connect. An aggressive sphenoid wing meningioma causing foster. Sphenoid wing meningiomas, or ridge meningiomas, are the most. Pedicled pericranial grafts for the repair of dural tears in the anterior fossa of the skull. Postoperative radiation therapy is indicated in cases with residual tumor in these locations. Benign sphenoid wing meningioma presenting with an. 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. Modern surgical outcomes following surgery for sphenoid wing. It extended laterally to the frontotemporal convexity with a broad dural attachment, giving the appearance of an en plaque meningioma. 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.
These are called the meninges and also help to protect the brain. 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. Sphenoid wing en plaque meningioma development following craniopharyngioma surgery and radiotherapy. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. 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. 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.
Objective medial sphenoid wing meningiomas swms are relatively common. Links to pubmed are also available for selected references. This case report presents the case of a sphenoid wing meningioma in. Get a printable copy pdf file of the complete article 2. Robert solomon im living a normal life for the first time. Sphenoid wing meningioma progression after placement of a. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. 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 ridge meningiomas represent approximately 20% of supratentorial meningiomas, among which less than half arise from the medial ridge of the sphenoid. Sphenoorbital meningioma, also known as meningioma en plaque of the sphenoid wing, usually arises from the lesser wing of the sphenoid bone, is. 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 ridge meningioma presenting as acute cerebral. Sphenoid wing meningiomas swms account for approximately 1520% of intracranial meningiomas. This is the name given to the protective lining of the brain and spinal cord.
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. Rosaidorfman disease mimicking a sphenoid wing meningioma. Sphenoid wing meningioma is a common entity in females worldwide. Based on this classification, meningiomas of this region can be divided into clinoidal, middle, or lateral. At microsurgical excision, the lesion was firm and relatively avascular.
Foster kennedy syndrome is a rare entity found with intracranial neoplasms. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing. 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. Meningiomas arising in the sphenoid region are frequently encountered in neurosurgical practice.
However, accumulating anatomical knowledge and clinical experience has shown that anterior clinoidal. Surgical management of sphenoid wing meningiomas clinical gate. Meningiomas that grow from the dura mater of the sphenoid ridge are a classic subtype of the skull base meningiomas. 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. Predictors of visual outcome following surgical resection of. They account for 11% to 18% of cases in large surgical series. A medial sphenoid wing meningioma with minimal medial extension is shown upper images. Compared with other meningiomas, swms possess higher mortality, disability rate and recurrence rate. Sphenoid wing hyperostosis has been reported as high as 42% of all meningiomas in this area.
Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report radek fric, 1 john k. Meningioma brain tumor, meningioma treatment options mayfield. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. The tumor has filled the area where the temporal lobe normally lies. The surgical treatment of hyperostosing meningiomas of the 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. Large and giant medial sphenoid wing meningiomas involving vascular structures. Purpose we used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. The presenting features, operative details and complications were documented. Current approach to meningiomas of the medial sphenoid. The tumor was first described in 1910 by frotscher and becker as an autopsy finding in a 72yearold man. Pubmed pubmed citation articles by arthur ecker similar articles in pubmed. Madisons epilepsy cure meet the doctor video series complete.
Mri revealed an enhancing, duralbased, left lateral sphenoid wing. 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. 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. 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. This article is a general discussion of meningioma focusing on typical primary intradural meningiomas and the imaging findings of intracranial disease.
A previously healthy 52yearold man presented to the emergency room with acute onset left hemiparesis and dysarthria. Lateral orbitotomy approach for removing hyperostosing en. Brain ct showed an enhancing mass consistent with a right sided sphenoid wing meningioma figure a. The rates of optic canal invasion medial 50% vs middle 5% vs lateral 0%.
Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. In some cases, deletions involving chromosome 22 are involved. Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. Imaging and clinical characteristics of temporal bone meningioma. Right pterional craniotomy was performed and a tumour located under and adherent to the overlying dura was identified. Meningiomas are presumed to account for 15% of brain tumours and are the most common tumours of the sphenoid wing 21, 22. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. We report an unusual case of a benign lateral sphenoid wing meningioma that presented with, and was masked by, an acute intracerebral. Reconstruction after resection of sphenoid wing meningiomas. Askep meningioma pdf sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Total removal with a prospect for cure and visual preservation should be the goal of treatment. Hyperostosing meningioma of pterion clay model as aid in surgical excision without bone flap. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Hyperostosis and secondary bone formation at the origin of the tumor in the region of the anterior clinoidal process are indicated by arrowheads.
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