Alar frontotemporal craniotomy extradural resection of the lesser wing of the sphenoid bone. The sphenoid wing is a relatively common site for a meningioma. Yes, its possible to have a meningioma of the sphenoid wing on imaging that arises from the meninges not the bone. Challenging the osseous component of sphenoorbital meningiomas. Meningiomas arising in the sphenoid region are frequently encountered in neurosurgical practice. Benign sphenoid wing meningioma presenting with an acute. 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 it exerts a compressive effect on the adjacent skull foramina as compression on the optic nerve. Globoid meningiomas 1 deep, inner, or clinoidal 2 middle or alar 3 lateral, outer, or pterional 11. Mri findings that the meningioma is near the optic nerves.
Mri and ct scans were utilized to analyze soft tissue and bone extension, respectively. Surgical management of giant sphenoid wing meningiomas. Meningiomas are much more common in females, and are more common after 50 years of age. The purpose of this study was to determine the role of routine pi and its impact on clinical decision making after resection of meningioma. B, a coronal cut demonstrating the sphenoid wing meningioma extending into the internal auditory canal. These are called the meninges and also help to protect the brain. Sphenoid wing meningioma mri mri brain axial t2, t1 and post contrast t1. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Sphenoid wing meningioma presenting as sudden sensorineural. Meningioma tumours are more common in older people and in women, although they may occur in men and in young people too. It exerts a compressive effect on the adjacent skull foramina as compression on the optic nerve. Imaging revealed a large leftsided sphenoid wing meningioma. They may occasionally, however, exhibit a more infiltrating growth pattern over the dura, termed meningioma en plaque fig.
This is the name given to the protective lining of the brain and spinal cord. Sphenoid wing hyperostosis has been reported as high as 42% of all. Sphenoid wing en plaque meningioma development following. Objective medial sphenoid wing meningiomas swms are relatively common tumors. The archetypal imaging characteristics of meningiomas are among the most. Predictors of visual outcome following surgical resection of. Sphenoid wing meningiomas could pose a unique challenge due to the difficulty associated with gross total resection, particularly in cases of cavernous sinus infiltration. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. They typically have a broadbased dural attachment and, if sufficiently large, inward displacement of the cortical grey matter. This article is a general discussion of meningioma focusing on typical primary intradural meningiomas and the imaging findings of intracranial disease. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Degree of vascular encasement in sphenoid wing meningiomas.
Easy program selection via automated motor recognition. When the site of origin is described as along the sphenoid wing or overlying the sphenoid wing report the meningioma. Also known as sphenoorbital meningiomas or hyperostotic meningiomas of the sphenoid wing, enplaque meningiomas refer to tumors with a carpetlike dural growth, which are associated with a reactive hyperostosis that, in most cases, is marked and principally responsible for clinical manifestations 5, 6. Transorbital management of sphenoid wing meningiomas. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing.
Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. A very thin layer of soft tissue thickening was visible both in ct scan and mri. Mri allows better delineation of the soft tissue component of the tumor and dural. En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Medial sphenoid wing meningioma the neurosurgical atlas, by. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. In some cases, examination of a sample of the tumor biopsy may be needed to rule out other types of tumors and confirm a meningioma. In general, convexity, parasagittal, and sphenoid wing meningiomas are. Olfactory groove and sphenoid wing meningiomas altair health.
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. Current approach to meningiomas of the medial sphenoid wing and. Hald, and ellenann antal journal of central nervous system disease 2016 10. Sphenoid wing meningiomas are a heterogeneous group of tumors with. Isoin tense mass with nodular black rim large arrow, which is most prominent posteriorly.
With stereotactic imageguided techniques the surgeon uses an mri based 3d model of the patients brain much like a gps system to safely. Two had solitary while the third had multiple meningiomas. Olfactory groove and sphenoid wing meningiomas columbia. Meningiomas en plaque have diffuse hyperostosis, more frequently observed over the sphenoid wing and pterion.
Sphenoid wing meningiomas extending to the orbit epmsw are. This is sphenoid wing meningioma by surgical neurology international on vimeo, the home for high quality videos and the people who love them. A, an axial cut depicting the size of the sphenoid wing meningioma and its mass effect on the brain stem. Lateral orbitotomy approach for removing hyperostosing en plaque. Jan 19, 2016 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. The differential diagnosis included mainly neurosarcoidosis and sphenoid wing meningioma. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report radek fric, john k. With this imaging study, a magnetic field and radio waves are used to create crosssectional images of the structures within your brain. Mar 01, 2004 as an introduction, she offered the hypothetical case of a 40yearold woman who undergoes excision of a sphenoid wing meningioma. 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.
There might be no dural tail in sphenoid wing meningioma. The lesion results in marked hyperostosis of the greater wing of sphenoid with resultant indentation. The presenting features, operative details and complications were documented. April 2012 path left sphenoid wing tumor biopsy and resection. Meningioma brain tumor, meningioma treatment options mayfield.
Background routine postoperative imaging pi following surgery for intracranial meningiomas is common practice in most neurosurgical departments. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura. 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. Total surgical resection is difficult and therefore these tumors have high.
Many of the histological variants are also discussed separately. A postoperative scan yields residual tumor in the apex. Extraaxial mass centered near the medial rt sphenoid wing which extends medially into the cavernous sinus. In spite of these developments, as well as advancements in neuroimaging. According to our data, application of a multimodal image guidance provided. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis. Mri scans provide a moredetailed picture of the brain and meningiomas. Complete removal is difficult, so these tumors have high rates of. 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. Dec 18, 2019 ct scan brain bone window showing intraosseous meningioma involving left sphenoid wing, lateral orbital, superior orbital fissure, and the anterior part of the middle fossa floor. Authors report an 8yearold female, who was operated for craniopharyngioma and received adjuvant therapy, was asymptomatic for next 30 years, met a road traffic accident and magnetic resonance imaging brain revealed incidental right sphenoid wing en plaque meningioma.
Growth pattern analysis of sphenoid wing meningiomas. Sphenoid wing meningioma, hypoin tense rim and mottling. Tumor consistency was found to be fibrous in 5 cases and soft in 7. 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. The differential diagnosis for sphenoid wing meningioma includes other types of tumors such as optic nerve sheathe meningioma, cranial osteosarcoma, metastases, and also sarcoidosis. A more true medial sphenoid wing clinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. Resection of skull base medial sphenoid wing meningioma. Resection of skull base medial sphenoid wing meningioma mary ann posted wed 26th of june, 20 17.
Jan 08, 2014 postcontrast coronal t1weighted sequence in a 33yearold woman who presents with right proptosis demonstrates extensive dural thickening and enhancement along the greater wing of sphenoid consistent with an en plaque meningioma large arrow. The role of imaging in the follow up of meningiomas. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. Sphenoid wing hyperostosis has been reported as high as 42% of all meningiomas in this area. Meyers is snis 2010 annual meeting chairman announcing dr. Mri brain t2w left and t1w fatsat right sequences showing involvement of the left sphenoid wing associated with dural thickening and the periorbita. Surgical management of sphenoid wing meningiomas clinical gate. Sphenoid wing meningiomas swms can encase arteries of the. Mr findings in patients with recurrent meningioma of the sphenoid wings k. Associated extraosseous left intraorbital small soft tissue component is seen near the orbital apex compressing and displacing the optic nerve. Note nodular nd contiguous curvilinear foci small arrows of hypointensity within mass, which produces overall mottling effect. The meningiomas, their classification, regional behaviour, life history, surgical end results. Mr imaging showed a large sphenoid wing tumor invading the brain with.
Inside the skull, and covering the brain, are 3 thin sheets of body tissue. Pdf hyperostotic sphenoid wing meningioma en plaque. Inflammatory and infectious lesions such as neurosarcoidosis have low rcbv values zoran rumboldt. Hyperostosis, which is the most commonly associated bony finding, manifests as bony thickening on ct and is seen in up to 2549% of meningiomas, with the convexity and sphenoid wing the most common locations. Imaging and diagnostic advances for intracranial meningiomas. Following the physical exam, the diagnosis is confirmed with neuroimaging. Perfusion weighted imaging shows very high rcbv with rapid wash in typical for extraxial lesions where no blood brain barrier exists and delayed washout. Meningioma im scared to watch and wait mayo clinic. Is postoperative imaging mandatory after meningioma removal.
C, an axial cut demonstrating the sphenoid wing meningioma extending into the internal auditory canal. They account for 11% to 18% of cases in large surgical series. Large and giant medial sphenoid wing meningiomas involving vascular structures. In the case of pure sphenoid wing meningiomas, recurrence rates were. The imaging characteristics are like those elsewhere in the brain, with avid. 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. Pdf the role of imaging in the follow up of meningiomas. The tumor has filled the area where the temporal lobe normally lies. Meningiomas typically appear as lobular, extra axial masses with wellcircumscribed margins fig.