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. Medially, this tumor may expand into the wall of the cavernous sinus, anteriorly into the orbit, and. Surgical management of medial sphenoid wing meningiomas is challenging because of the closely. Original article surgical management of sphenoid wing. Roberto heros, md brain surgery, carotid endarterectomy. Sphenoid ridge meningiomas represent approximately 20% of supratentorial meningiomas, among which less than half arise from the medial ridge. Pdf sphenoid wing meningioma presenting as cognitive. A 50yearold female presented to the neurosurgery clinic with dimness of vision and proptosis of her right eye.
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. In some cases, deletions involving chromosome 22 are involved. Improvement of longterm blindness caused by compression. This is the name given to the protective lining of the brain and spinal cord. All 6 patients with meningiomas en plaque were female and had hyperostosis. Basso and colleagues subdivide meningiomas of the inner third of the sphenoid wing into clinoidal and sphenocavernous tumors. Sphenoid wing meningioma progression after placement of a subcutaneous progesterone agonist. They present a unique challenge to otolaryngologists and neurosurgeons regarding diagnosis and treatment when contiguous intracranial involvement is present. According to their location along the sphenoid wing, sphenoid wing meningiomas are classified into. Olfactory groove meningiomas grow near the olfactory nerve, located between the brain and the nose.
Jan 25, 2019 cluster headache is generally considered to be a primary headache. The authors report a rare case of an osteolytic mep extending from the sphenoid wing into the orbital wall, middle fossa, and temporalis muscle. Posterior fossa meningioma develops at the back of the brain. Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. 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.
This is a complete video of surgical approach pterional craniotomy and resection of sphenoid wing meningioma benign brain tumor. Extracranial meningiomas of the sphenoid sinus are extremely rare. See related sections symptoms and diagnosis and treatments the tumors location is most often included in its description. Encasement of the ica and its branches was observed in the majority of cases 71. Laws, md pituitary surgery, epilepsy surgery, peripheral nerve surgery. Oct 01, 2011 read sphenoid ridge meningioma presenting as ischemia stroke, anz journal of surgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. These are called the meninges and also help to protect the brain.
Following the physical exam, the diagnosis is confirmed with neuroimaging. The invasion of the sphenoid ridge and of the orbital walls by an en plaque meningioma may produce their osteolysis and easy decompression of the orbit 16. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. Intraosseous meningioma of the sphenoid bone sciencedirect. Sphenoid ridge meningioma presenting as ischemia stroke, anz. Sphenoid ridge meningioma presenting as ischemia stroke sphenoid ridge meningioma presenting as ischemia stroke cheng, hsien. Pdf hyperostotic sphenoid wing meningioma en plaque. Middleaged man, with epilepsy and speech arrest due to meningioma of left inner sphenoid ridge. 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. These types of meningiomas often grow as part of a larger lesion within the sphenoid bone.
Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Figure 322 large medial sphenoid wing meningioma a, mr appearance of a large meningioma of the right medial sphenoid wing upper panel. An osteolytic meningioma en plaque of the sphenoid ridge ncbi. The meningioma extended along the anterior and middle. 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. Medial displacement of the lateral rectus from the sphenoid wing mass. 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. Meningioma tumor locations brain science foundation. Foramen magnum meningiomas start off in the hole in the base of the skull that the spinal cord passes through called the foramen magnum. The figure also shows a contrastenhanced, t1weighted axial mri view of three left globoid swms.
A 60yearold asian woman presented to a nearby hospital with the chief complaint of left facial palsy. C, ct scan with bone window showing medial sphenoid meningioma with intraosseous tumor involvement. Pdf benign sphenoid wing meningioma presenting with an acute. Surgery by dammers and schouten, erasmus medical center, rotterdam, the netherlands. The longawaited second edition of kempes operative neurosurgery is being prepared by dr.
A, contrastenhanced ct axial view of a right enplaque meningioma. Parkinsonism was completely relieved after tumor resection. Sphenoid wing meningioma presenting as hemiparkinsonism. Meningioma im scared to watch and wait mayo clinic. Fortyseven patients had involvement of the sphenoid ridge and 6 of them fulfill the criteria for meningioma en plaque. Meningiomas are presumed to account for 15 % of brain tumours and are the most common tumours of the sphenoid wing. Approximately 1520% of all meningiomas arise from the sphenoid wing, with about half of these arising from the medial portion of the wing. 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. As cushing and eisenhardt 5 put it in their monography published in 1938. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. Meningioma im scared to watch and wait mayo clinic connect. Dec 18, 2019 sphenoid wing meningiomas are also known as orbitosphenoid meningiomas, meningiomas en plaque of the sphenoid wing, and sphenoid wing meningiomas with osseous involvement. 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.
Reported 3 pts operated for meningioma bw 1903 1932 101016 2. Sphenoid wing meningioma presenting as cognitive impairment article pdf available in shanghai archives of psychiatry 283. Below is a listing of locations where meningiomas are found. A more true medial sphenoid wingclinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Its external surface is related to the temporal, infratemporal, and pterygopalatine fossa. The main symptoms of patients with sphenoid wing meningiomas are proptosis, visual loss and orbital pain. Reconstruction after resection of sphenoid wing meningiomas. A 65yearold asian woman presented with a 6month history of blindness caused by a meningioma located on the inner third of the sphenoid ridge. Patients and methods between march 2011 and june 2014, a prospective study including 30 patients with meningiomas primarily originating from sphenoid ridge was done. Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. Oct 10, 2016 the rate of recurrence for medial sphenoid wing meningiomas is reported as being one of the highest amongst intracranial meningiomas. Brain tumors meningiomas professor alhakam abdul mawla. Sphenoid wing meningioma mri mri brain axial t2, t1 and post contrast t1.
Lesions confined to the sphenoid ridge europe pmc article. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. It usually manifests as progressively developing neurological deficit. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Meningiomas are common tumors, accounting for 14 to 18% of intracranial neoplasms. Meningiomas are much more common in females, and are more common after 50 years of age. 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. Apr 27, 2017 this is a complete video of surgical approach pterional craniotomy and resection of sphenoid wing meningioma benign brain tumor. Olfactory groove and sphenoid wing meningiomas columbia. They are considered to be benign tumours arising from cap cells located in clusters around the arachnoid granulations that exist in.
Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary fossa. The meningiomas, their classification, regional behaviour, life history, surgical end results. Inside the skull, and covering the brain, are 3 thin sheets of body tissue. Furthermore, medial clinoidal meningiomas are further differentiated into 3 subcategories based on their relation to the anterior clinoidal process. Meyers is snis 2010 annual meeting chairman announcing dr. Syndrome of meningeal fibroblastoma arising from lesser wing of. 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. A 54yearold woman presented with a 2month history of tremor, particularly at rest, in the left upper limb and 2 episodes of generalized seizures. 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. Surgical management of sphenoid wing meningiomas clinical gate. Axial t1 and t2w mri sections show an extra axial dura based solid signal intensity mass, overlying lateral sphenoid wing, homogenously iso intense to cortical grey matter on t1 and t2w images, intense homogenous enhancement on post contrast t1 with dural tailing. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. However, acute cerebral infarction, resulting from intracranial arterial occlusion or obstruction related to meningioma is extremely rare 4, 9, 15.
Observe the hyperostosis on the entire sphenoid ridge, associated with a small dural component. 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. Sphenoid wing meningiomas may be associated with hyperostosis of the sphenoid ridge and may be very invasive, spreading to the dura of the frontal, temporal. Get a printable copy pdf file of the complete article 2. Meningioma tumours are more common in older people and in women, although they may occur in men and in young people too. Cushing and eisenhardt were the first to describe sphenoid ridge meningiomas in detail. Based on this classification, meningiomas of this region can be divided into clinoidal, middle, or lateral sphenoid wing. Despite a tendency to invade venous sinuses, it has been reported that meningiomas do not infiltrate arterial structures. It has been well documented that these tumors may invade bone, muscle, dura, or the dural sinuses. Simpson grade ii resection through pterional approach with opening of sylvian fissure. Here, we describe an unusual case with clusterlike headache 2. These intracranial meningiomas may be associated with hyperostosis of the sphenoid ridge and may be very invasive, spreading to the dura of the frontal, temporal, orbital, and sphenoidal regions. Meningiomas are considered benign tumors that arise from cap cells of the arachnoid granulations and are the most common tumors of the sphenoid ridge.
Aug 14, 2017 extracranial meningiomas of the sphenoid sinus are extremely rare. Here, the authors report a case of sphenoid ridge meningioma presenting with acute cerebral infarction caused by middle cerebral artery mca compression. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. This is sphenoid wing meningioma by surgical neurology international on vimeo, the home for high quality videos and the people who love them. Lateral sphenoid wing meningiomas arise from the pterion and typically grow along the sylvian fissure. Medial sphenoid wing meningioma the neurosurgical atlas. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Clusterlike headache secondary to anamnesis of sphenoid. We report an unusual case of a benign lateral sphenoid wing meningioma that presented with, and was masked by, an. This mass extends lateral wall of right orbit and medial aspect of right temporalis muscle. Meningiomas vary in their symptoms and appropriate treatment options depending on their location. 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. Original article surgical management of sphenoid wing meningiomas.
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. The differential diagnosis for sphenoid wing meningioma includes other types of tumors such as optic nerve sheath meningioma, cranial osteosarcoma, metastases, and also sarcoidosis. 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. When planning the surgical treatment of an en plaque meningioma of the sphenoid wing, the extension of both tumor components dural. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. 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. 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. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura.
Sphenoid wing meningiomas are categorized as lateral, middle, or medial clinoidal, depending on the origin of the tumor along the sphenoid ridge. Pdf an osteolytic meningioma en plaque of the sphenoid ridge. The medial part of the sphenoid ridge is formed by the ala minor, and the lateral part by the ala major. The clusterlike headache and meningioma were on the same side, and even at the same position. 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. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Many workers27 have testified as to the invasive capabilities of this neoplasm, reporting it in the frontal sinuses, the mid dle ear, the calvarium, and the scalp, among other places. Axial t2weighted a and t1weighted b images show an extraaxial mass in the right sphenoid ridge area.
The inner two thirds roughly correspond to the posterior margin of the lesser sphenoidal wing ala parva. This type of meningioma occurs near the nerves that connect the brain to the nose. A benign sphenoid ridge meningioma manifesting as a. Sphenoid ridge meningioma presenting as ischemia stroke. Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region from the temporal fossa. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. Cluster headache is generally considered to be a primary headache. Medial sphenoid wing meningioma the neurosurgical atlas, by. Apparently, the sphenoid ridge meningiomas often combine a marked invasive tendency with a. Neurosurgical resection of sphenoid wing meningiomas with microsurgical technique. Improvement of longterm blindness caused by compression from. Surgical management of giant sphenoid wing meningiomas.
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