Meningiomas, their classification, regional behavior, life history and surgical end results. Their classification regional behaviour life history and surgical end results. 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. Apr 27, 2017 this is a complete video of surgical approach pterional craniotomy and resection of sphenoid wing meningioma benign brain tumor. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid. Meningioma tumours are more common in older people and in women, although they may occur in men and in young people too.
Furthermore, medial clinoidal meningiomas are further differentiated into 3 subcategories based on their relation to the anterior clinoidal process. There are no pathologic or genetic features specific to lateral and middle sphenoid wing meningiomas, although world health organization who class ii and iii meningiomas. Here, we describe an unusual case with clusterlike headache 2. Hyperostotic sphenoid wing meningioma en plaque romanian. Based on this classification, meningiomas of this region can be divided into clinoidal, middle, or lateral sphenoid. Sphenoid wing meningioma in magnetic resonance imaging t1w contrast enhanced sphenoid wing meningioma in computed tomography which shows the reactive orbital hyperostosis a sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. Surgical management of meningioma en plaque of the sphenoid ridge.
Meningioma en plaque represents a morphological subgroup within the meningiomas. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Medial sphenoid wing meningioma the neurosurgical atlas, by. Total removal of large global meningiomas at the medial aspect of the sphenoid ridge. Original article surgical management of sphenoid wing meningiomas. The greater wing of the right sphenoid bone as well as the right lateral orbital wall and the orbital roof show expansion by a well defined lesion of dark signal on all pulse sequences. The tumor, which was consistent with a sphenoid ridge meningioma, encased and compressed the right ica terminus.
Mar 01, 2008 in 1938, cushing and eisenhardt reported the first surgical experience with meningiomas of the sphenoid ridge. In cases of orbital disease with extraocular muscle enlargement, a further search for evidence of orbital neoplasia. The rate of recurrence for medial sphenoid wing meningiomas is reported as. Neurosurgical resection of sphenoid wing meningiomas with microsurgical technique. There are no pathologic or genetic features specific to lateral and middle sphenoid wing meningiomas, although world health organization who class ii and iii meningiomas are less common in this region of the brain than over the convexities. Sphenoid ridge meningiomas represent approximately 20% of supratentorial meningiomas, among which less than half arise from the medial ridge. We report a rare case of a microcystic meningioma at the sphenoid ridge. Dec 18, 2019 sphenoid wing meningiomas are categorized as lateral, middle, or medial clinoidal, depending on the origin of the tumor along the sphenoid ridge. We describe the case of a 47 years old woman with meningotelial sphenoid ridge meningioma which was. Lateral sphenoid wing meningiomas arise from the pterion and typically grow along the sylvian fissure. An osteolytic meningioma en plaque of the sphenoid ridge. Mr findings in patients with recurrent meningioma of the sphenoid wings k.
The miracle on fort washington avenue aneurysm surgery is a personal choice, says dr. En plaque sphenoid wing meningioma is morphological unique in comparison with. Sphenoid ridge meningioma presenting as ischemia stroke, anz. Madisons epilepsy cure meet the doctor video series complete. Brain tumors meningiomas professor alhakam abdul mawla.
Improvement of longterm blindness caused by compression. Meningiomas of the sphenoid wing and middle cranial fossa. Sep 30, 2018 lateral sphenoid wing meningiomas arise from the pterion and typically grow along the sylvian fissure. Medial sphenoid wing meningioma the neurosurgical atlas. Those at the sphenoid ridge, as in our case, tend to present with visual disturbances such as diplopia and proptosis 5. Neuroradiologic images revealed typical meningiomas of the sphenoid ridge with extensive perifocal edema.
This is sphenoid wing meningioma by surgical neurology international on vimeo, the home for high quality videos and the people who love them. The progression of neuroophthalmologic signs and symptoms caused by cavernous sinus meningiomas csms was evaluated in 24 patients. If the inline pdf is not rendering correctly, you can download the pdf file here. Meningiomas are sometimes accompanied by a degree of peritumoral edema, one cause of which is venous congestion because of cerebral venous sinus occlusion as a result of a parasinus tumor. Dr reifler and colleagues 1 presented a case of proptosis, visual field loss, and optic neuropathy but misinterpreted it as one of thyroid orbitopathy. Meningioma im scared to watch and wait mayo clinic connect.
This is the third most frequent site for intracranial meningiomas after the convexity and parasagittal regions, constituting about 25% of intracranial meningiomas. Avid homogenous contrast enhancement of the sphenoid wing mass with significant right proptosis, with the sphenoid. A diagnosis of bells palsy was made, however at the same time, magnetic resonance imaging mri of the head revealed an incidental meningioma located on the innerthird of the left sphenoid ridge. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. Syndrome of meningeal fibroblastoma arising from lesser wing of. External carotid angiogram with the blush of sphenoid ridge meningioma fed by middle meningeal artery. In our large experience with sphenoid wing meningiomas at the university of miami, we have never used preoperative embolization and have. Lateral and middle sphenoid wing meningiomas springerlink. Cerebral angiography demonstrated complete occlusion of the right proximal m1 portion with slightly limited collateral circulation to the right mca territory and a radiographic blush from the surrounding meningioma. Objective sphenoid wing meningiomas are a heterogeneous group of tumors.
Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura. Meningiomas involving the sphenoid wing outcome after. Meningiomas are much more common in females, and are more common after 50 years of age. The surgical treatment of hyperostosing meningiomas of the sphenoid. While graves disease may present as unilateral exophthalmos, most computed tomographic ct studies show multiple enlarged. Differential diagnosis of this lesion includes fibrous dysplasia, osteoma, and osteoblastic metastasis 1, 5, 17, 27. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis. Pdf an osteolytic meningioma en plaque of the sphenoid ridge. Meningiomas of the sphenoid ridge may produce unilateral exophthalmos through direct orbital invasion, hyperostosis and loss of orbital volume, venous. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Complete macroscopic removal of the tumor was performed. They account for 11% to 18% of cases in large surgical series.
Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region. Cushing and eisenhardt 9 were the first to describe sphenoid ridge meningiomas in detail. The extent of tumor resection and postoperative complications were investigated. A more true medial sphenoid wingclinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Sphenoid wing meningioma presenting as cognitive impairment article pdf available in shanghai archives of psychiatry 283. The incidence of acute cerebral infarct, as reported in the internal carotid artery ica territory, resulting from arterial occlusion or obstruction related to meningioma is very rare. A sizable extraaxial mass lesion is noted at the right middle cranial fossa measuring 2. Jan 25, 2019 cluster headache is generally considered to be a primary headache. Clusterlike headache secondary to anamnesis of sphenoid.
A 30yearold female patient with primary intraosseous meningioma of the right greater sphenoid. Sphenoid ridge meningioma with increased intracranial. Pdf sphenoid wing meningioma presenting as cognitive. Ten patients had primary involvement of the cavernous sinus by meningioma, and 14 patients had extension of a sphenoid ridge meningioma. Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. Meningiomas of the skull base locations constitute 40% of all intracranial meningiomas.
The sphenoid bone is located in the center of the cranial base figures 103 and 105. On the basis of clinical observations and anatomic characteristics obtained during surgery or autopsy in 53 patients, they divided sphenoid ridge meningiomas into four categories. As cushing and eisenhardt 5 put it in their monography published in 1938. Meningiomas arise from arachnoidal cells, most of which are near the vicinity of the venous sinuses, and this is the site of greatest prevalence for meningioma formation they most frequently are attached to the dura over the superior parasagittal surface of frontal and parietal lobes, along the sphenoid ridge, in the olfactory grooves, the sylvian region, superior cerebellum along the falx. They present a unique challenge to otolaryngologists and neurosurgeons regarding diagnosis and treatment when contiguous intracranial involvement is present. Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region from the temporal fossa. A 60yearold asian woman presented to a nearby hospital with the chief complaint of left facial palsy. Sphenoorbital meningiomas soms are secondary tumours of the orbit that originate from the dura of the sphenoid wing bone. Patients were divided into the following groups based on the site of the tumor. Keywords internal carotid artery bone flap middle meningeal artery intracranial meningioma anterior clinoid process. Some meningiomas can cause problems despite their benign nature. 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.
Sphenoorbital meningioma is a rare entity that accounts for 0. Rate of progression and severity of neuroophthalmologic. Surgical management of meningioma en plaque of the. Oct 01, 2011 sphenoid ridge meningioma presenting as ischemia stroke it usually manifests as progressively developing neurological deficit. We describe the case of a 47 years old woman with meningotelial sphenoid ridge meningioma which was totally removed. Sphenoid wing sw en plaque meningioma epm is a subgroup of meningiomas defined by its specific character presenting with a rather thin sheath of soft tumor tissue accompanied by disproportionate and extensive bone hyperostosis. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement.
Lateral orbitotomy approach for removing hyperostosing en. Surgical resection of 5 cm medial sphenoid wing meningioma encasing carotid artery. Surgical management of giant sphenoid wing meningiomas. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. Olfactory groove and sphenoid wing meningiomas columbia. The clusterlike headache and meningioma were on the same side, and even at the same position.
A 65yearold asian woman presented with a 6month history of blindness caused by a meningioma located on the inner third of the sphenoid ridge. Large and giant medial sphenoid wing meningiomas involving vascular structures. We present a case of a secondary sphenoid sinus meningioma extending from the temporal fossa and medial sphenoid ridge. Part of the advances and technical standards in neurosurgery book series neurosurgery, volume 14. Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary fossa. A medial sphenoid wing meningioma with minimal medial extension is shown upper images. It displayed welldefined outlines and homogeneous t1t2 isointense matrix to the brain. Pdf hyperostotic sphenoid wing meningioma en plaque. Reconstruction after resection of sphenoid wing meningiomas. The rate of recurrence for medial sphenoid wing meningiomas is reported as being one of the highest amongst.
Cluster headache is generally considered to be a primary headache. The meningioma extended along the anterior and middle. Of these, about one half occur in the sphenoid wing. 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. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing and eisenhardt. Meningiomas arising in the sphenoid region are frequently encountered in neurosurgical practice. The sphenoid ridge is the most common site for meningiomas en plaque, but other locations in the convexity may be affected as well 7, 17, 18, 20. Download as pdf print show related cases notify admin. There has been no previous case report of a patient whose visual acuity improved after longterm blindness caused by tumor invasion into the optic canal. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. Cerebral angiography demonstrated complete occlusion of the right proximal m1 portion with slightly limited collateral circulation to the right mca territory and a radiographic blush from the surrounding meningioma fig.
Internal carotid angiogram shows significant feeding of the tumour also from small meningeal branches of the internal carotid artery. Of all cranial meningiomas, about 20% of them are in the sphenoid. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. The innovation of the method and its actual clinical value is discussed in the example of a meningioma of the sphenoid which has been examined by both reconstruction modes. Dr reifler and colleagues1 presented a case of proptosis, visual field loss, and optic neuropathy but misinterpreted it as one of thyroid orbitopathy. Improvement of longterm blindness caused by compression from. Tuberculum sellae meningiomas tsms are lesions dramatically related to the optic apparatus once the principal clinical complain remains on visual alterations. Pitfalls of preoperative and palliative embolization of. Mep is a tumor of limited thickness that grows along the planes of the meninges and, in some cases, occupies a considerable area 2, 24. Original article surgical management of sphenoid wing. It is found almost exclusively in middleaged females whose symptoms are attributable to bony hyperostosis 8, 14, 26.
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