Apr 27, 2017 this is a complete video of surgical approach pterional craniotomy and resection of sphenoid wing meningioma benign brain tumor. Meningiomas that grow from the dura mater of the sphenoid ridge are a classic subtype of the skull base meningiomas. Lateral and middle sphenoid wing meningiomas springerlink. Original article surgical management of sphenoid wing meningiomas. Clusterlike headache secondary to anamnesis of sphenoid. These tumors can cause visual problems, loss of sensation in the face, or facial numbness. Reconstruction after resection of sphenoid wing meningiomas. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. The rate of recurrence for medial sphenoid wing meningiomas is reported as. A benign sphenoid ridge meningioma manifesting as a. Meningiomas may originate in unexpected locations such as the orbit, paranasal sinus, or ventricles or be entirely intraosseous within the calvaria. Large and giant medial sphenoid wing meningiomas involving vascular structures.
A more true medial sphenoid wingclinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Original article surgical management of sphenoid wing. The foramen lacerum is located at the junction of the temporal. 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.
En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas. Patients and methods between march 2011 and june 2014, a prospective study including 30 patients with meningiomas primarily originating from sphenoid ridge was done. These meningiomas involve the region of the anterior clinoid, adjacent medial sphenoid wing, superior orbital fissure, and cavemous sinus. Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. An osteolytic meningioma en plaque of the sphenoid ridge article pdf available in journal of korean neurosurgical society 431.
Continuous progression of hemorrhage of sphenoid ridge. The tumor, which was consistent with a sphenoid ridge meningioma, encased and compressed the right ica terminus. Pdf hyperostotic sphenoid wing meningioma en plaque. Sphenoid wing meningiomas among difficult surgery tumours due to involvement of important structures like optic nerve, cavernous sinus. Furthermore, medial clinoidal meningiomas are further differentiated into 3 subcategories based on their relation to the anterior clinoidal process. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. The optic nerve, ophthalmic artery and accompanying sympathetic plexus course through this canal as. Meningioma en plaque of the sphenoid ridge en plaque meningiomas characteristically lead to slowly increasing proptosis with the eye angled downward. For example, a parasagittal meningioma is located near the sagittal sinus, a major blood vessel at the top of the cerebral hemispheres. Cerebral angiography demonstrated complete occlusion of. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis.
We report a case of a meningotheliomatous type of sphenoid ridge meningioma that manifested as an sah, caused by tumor invasion into a middle cerebral artery mca. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. The authors report a series of 34 meningiomas of the sphenoid ridge. More difficult was the total removal of meningiomas of the inner third or of the entire sphenoid ridge 47%. Recurrence of meningiomas and its management clinical gate. Meningiomas are benign slowgrowing tumors that originate from the outer covering layers of the brain. In cases of orbital disease with extraocular muscle enlargement, a further search for evidence of orbital neoplasia is indicated only in the presence of features that are atypical for a benign process. Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region from the temporal fossa. Sphenoid ridge lymphoplasmacyterich meningioma sciencedirect. Here, the authors report a case of sphenoid ridge meningioma presenting with acute cerebral infarction caused by middle cerebral artery mca compression. The meningioma extended along the anterior and middle. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. With invasion of the tumor into the orbit, diplopia is common. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura.
A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. The middle fossa is a common localization for intracranial meningiomas. The frontotemporoorbitozygomatic approach ftoza is an alternative to the pterional approach in surgical resection of meningiomas of the medial part of the lesser wing of the sphenoid bone. Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing and eisenhardt. The meningiomas, their classification, regional behaviour, life history, 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. The purpose of this study is to present our results of. Outcome of medial sphenoidal wing meningioma surgery. The floor of the middle cranial fossa is formed by the greater wing of the sphenoid bone joining the squamosal part of the temporal bone. Sphenoid ridge meningioma masquerading as graves orbitopathy. Mar 01, 2008 in 1938, cushing and eisenhardt reported the first surgical experience with meningiomas of the sphenoid ridge. Sphenoid ridge meningioma presenting as acute cerebral.
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. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary fossa. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. A previously healthy 52yearold man presented to the emergency room with acute onset left hemiparesis and dysarthria. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures.
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. 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. Objective medial sphenoid wing meningiomas swms are relatively common. Pdf an osteolytic meningioma en plaque of the sphenoid ridge. Surgical management of medial sphenoid wing meningiomas is challenging because of the closely. 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. 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. However, it is known that these tumors may invade bony structures, even in the benign meningotheliomatous type 2. Case report a 47 years old woman with right sphenoid ridge tumor was operated in 2003. If the inline pdf is not rendering correctly, you can download the pdf file here. Total surgical resection is difficult and therefore these tumors have high recurrence rates. They are frequently located along the falx, convexity, and the sphenoid ridge.
Its name is derived from the greek sphenoeides, to mean wedgeshaped. Sphenoid ridge lymphoplasmacyterich meningioma joonkhim loh,1,2 shiuhlin hwang,3 kunbow tsai,4 aijlie kwan, 3shenlong howngg there are numerous histologic variants of meningioma. Of these, about one half occur in the sphenoid wing. You will find out more about body changes and other things that can signal a problem that may need medical care. In 1938, cushing and eisenhardt reported the first surgical experience with meningiomas of the sphenoid ridge. Neurosurgery video lateral sphenoid wing meningioma duration. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura.
Their classification regional behaviour life history and surgical end results. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. Medially, this tumor may expand into the wall of the cavernous sinus, anteriorly into the orbit, and laterally into the temporal bone. Meningiomas are much more common in females, and are more common after 50 years of age. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. In some cases, deletions involving chromosome 22 are involved. The clusterlike headache and meningioma were on the same side, and even at the same position. Clinical anatomy and physiology of the visual system third edition, 2012.
Predictors of visual outcome following surgical resection of. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. Five tumors were not operated on because of their extensions or the patients age. Sphenoid ridge meningioma manifesting as subarachnoid hemorrhage korean j radiol 9suppl, july 2008 s finding. Reported 3 pts operated for meningioma bw 1903 1932 101016 2. Medial sphenoid wing meningioma the neurosurgical atlas, by. Sphenoid wing meningiomas, or ridge meningiomas, are the most common of the basal meningiomas. Sphenoid bone location structure function teachmeanatomy.
In this article, we shall look at the anatomy of the sphenoid bone its location, structure, and clinical significance. Transorbital approach to sphenoid wing meningiomas 9 2. Optic canal the optic canal is an approximately 10mm bony corridor, the entrance of which is located in the superomedial orbital apex optic foramen. Case report a 52yearold man with no significant prior medical history was brought to our emergency room with drowsy mental status that lasted ten hours after the onset of left hemiparesis and dysarthria. The sphenoid bone is a single bone, the body of which lies in the midline and articulates with the occipital bone and the temporal bones to form the base of the cranium. 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. Sometimes, people with meningioma do not have any of these changes.
Hyperostosing meningiomas of the sphenoid ridgeclinical. The very challenging surgical considerations of clinoid meningiomas. Total removal was possible in 91% of the patients with meningiomas located at the pterion or middle third of the sphenoid ridge. Among the more uncommon are intracranial masses composed of meningiomatous and plasma celllymphocytic elements. Cluster headache is generally considered to be a primary headache. Typical, atypical, and misleading features in meningioma. The tumor often encases the intemal carotid and proximal middle and anterior cerebral arteries as well as the optic nerve and may compress or provoke edema in the temporal or frontal lobes. Meningiomas of the skull base locations constitute 40% of all intracranial meningiomas. Approximately 1520% of all meningiomas arise from the sphenoid wing, with about half of these arising from the medial portion of the wing. Medial sphenoid wing meningioma the neurosurgical atlas. Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia. The sphenoid ridge meningioma account approximately 20% of all supratentorial meningioma, on the other hand the half of it occurred in the medial sphenoid ridge. Incidence it is estimated that approximately 1% of the.
Medial sphenoid wing meningiomas swms pres ent a more difficult problem for neurosurgeons because they invariably involve the anterior visual pathways. Brain science foundations principal investigator, elizabeth claus, md, phd, and her team, recently published two articles on meningiomas. Or, the cause of a symptom may be a different medical condition that is not a. It originates from the arachnoidnot the dura, the tissue covering the brain and spinal cordlying deep to the dura. Syndrome of meningeal fibroblastoma arising from lesser wing of sphenoid. Medial sphenoid wing meningiomas are medially located tumors on the sphenoid wing with attachment over the anterior. The sphenoid bone is one of the eight bones that make up the cranium the superior aspect of the skull that encloses and protects the brain.
Sphenoid wing meningiomas are notoriously difficult tumors to manage due to their location and proximity to vital structures the optic nerve, superior orbital. Surgical management of giant sphenoid wing meningiomas. 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. Mr findings in patients with recurrent meningioma of the sphenoid wings k. In this case, the tumor involved also the sphenoid greater wing with extension into the middle.
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. Also, we excluded all meningiomas enplaque in this. As cushing and eisenhardt 5 put it in their monography published in 1938. Jan 25, 2019 cluster headache is generally considered to be a primary headache. Case report a 53yearold man presented with a sudden onset of severe diffuse headache followed by dizziness. Meningioma tumor locations brain science foundation.
886 439 1227 82 947 174 302 240 449 1044 1508 936 1142 345 174 837 121 1090 1355 1445 610 1052 768 1049 371 350 648 1647 245 1574 778 503 1074 1098 1493 1571 66 980 796 366 1162 963 903