Case report a 47 years old woman with right sphenoid ridge tumor was operated in 2003. The typical meningioma is a homogeneous, hemispheric, markedly enhancing extraaxial mass located over the cerebral convexity, in the parasagittal region, or arising from the sphenoid wing. 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. Reconstruction after resection of sphenoid wing meningiomas.
In this article, we shall look at the anatomy of the sphenoid bone its location, structure, and clinical significance. Sphenoid wing meningiomas, or ridge meningiomas, are the most common of the basal meningiomas. 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. Lateral and middle sphenoid wing meningiomas springerlink. The clusterlike headache and meningioma were on the same side, and even at the same position. 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. Patients and methods between march 2011 and june 2014, a prospective study including 30 patients with meningiomas primarily originating from sphenoid ridge was done. The meningiomas, their classification, regional behaviour, life history, surgical end results.
Total removal was possible in 91% of the patients with meningiomas located at the pterion or middle third of the sphenoid ridge. Meningiomas of the skull base locations constitute 40% of all intracranial meningiomas. Sphenoid wing meningiomas among difficult surgery tumours due to involvement of important structures like optic nerve, cavernous sinus. These meningiomas involve the region of the anterior clinoid, adjacent medial sphenoid wing, superior orbital fissure, and cavemous sinus. Of all cranial meningiomas, about 20% of them are in the sphenoid wing. Mr findings in patients with recurrent meningioma of the sphenoid wings k. 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. 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. With invasion of the tumor into the orbit, diplopia is common. The optic nerve, ophthalmic artery and accompanying sympathetic plexus course through this canal as. Clinical anatomy and physiology of the visual system third edition, 2012.
Cluster headache is generally considered to be a primary headache. In some cases, deletions involving chromosome 22 are involved. Case report a 53yearold man presented with a sudden onset of severe diffuse headache followed by dizziness. Sphenoid ridge meningioma masquerading as graves orbitopathy. Meningioma tumor locations brain science foundation. People with meningioma may experience the following symptoms or signs. Incidence it is estimated that approximately 1% of the. Cushing and eisenhardt 1938 divided the sphenoidal ridge into three equal portions. Medial sphenoid wing meningiomas swms pres ent a more difficult problem for neurosurgeons because they invariably involve the anterior visual pathways. Meningiomas may originate in unexpected locations such as the orbit, paranasal sinus, or ventricles or be entirely intraosseous within the calvaria. Optic canal the optic canal is an approximately 10mm bony corridor, the entrance of which is located in the superomedial orbital apex optic foramen. 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.
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. Recurrence of meningiomas and its management clinical gate. In this case, the tumor involved also the sphenoid greater wing with extension into the middle. Continuous progression of hemorrhage of sphenoid ridge meningioma causing cerebral hernia. The foramen lacerum is located at the junction of the temporal. Jan 25, 2019 cluster headache is generally considered to be a primary headache. Total removal of sphenoid wing en plaque meningiomas is difficult due to its extensive bone and dural involvement. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis. Sphenoid bone location structure function teachmeanatomy. Also, we excluded all meningiomas enplaque in this. Sphenoid ridge lymphoplasmacyterich meningioma sciencedirect.
Medial sphenoid wing meningiomas are medially located tumors on the sphenoid wing with attachment over the anterior. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by cushing and eisenhardt. Pdf hyperostotic sphenoid wing meningioma en plaque. We used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas. Apr 27, 2017 this is a complete video of surgical approach pterional craniotomy and resection of sphenoid wing meningioma benign brain tumor. Medial sphenoid wing meningioma the neurosurgical atlas. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. Large and giant medial sphenoid wing meningiomas involving vascular structures. 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.
Syndrome of meningeal fibroblastoma arising from lesser wing of sphenoid. Reported 3 pts operated for meningioma bw 1903 1932 101016 2. A more true medial sphenoid wingclinoidal meningioma with significant medial extension and encasement of the ica is also included lower images. Total surgical resection is difficult and therefore these tumors have high recurrence rates. En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas. Much of this is due to reactive orbital hyperostosis. Meningiomas are slowgrowing, expansile benign tumors that can involve the bone and dura. Meningiomas are benign slowgrowing tumors that originate from the outer covering layers of the brain. Hyperostosing meningiomas of the sphenoid ridgeclinical. Brain science foundations principal investigator, elizabeth claus, md, phd, and her team, recently published two articles on meningiomas. You will find out more about body changes and other things that can signal a problem that may need medical care. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. The middle fossa is a common localization for intracranial meningiomas.
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. A previously healthy 52yearold man presented to the emergency room with acute onset left hemiparesis and dysarthria. Continuous progression of hemorrhage of sphenoid ridge. The meningioma extended along the anterior and middle. Typical appearance of a sphenoid ridge meningioma with with extension into the cavernous sinus and pituitary fossa.
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. Neurosurgery video lateral sphenoid wing meningioma duration. 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. Meningioma tumors can be described based on their location. Original article surgical management of sphenoid wing meningiomas. As cushing and eisenhardt 5 put it in their monography published in 1938. However, it is known that these tumors may invade bony structures, even in the benign meningotheliomatous type 2. For spinal and primary extradural tumors refer to spinal meningioma and primary extradural meningioma articles respectively. Among the more uncommon are intracranial masses composed of meningiomatous and plasma celllymphocytic elements. Transorbital approach to sphenoid wing meningiomas 9 2.
The authors report a series of 34 meningiomas of the sphenoid ridge. 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. Objective medial sphenoid wing meningiomas swms are relatively common. Surgical management of giant sphenoid wing meningiomas. Of these, about one half occur in 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. Sphenoid ridge meningioma presenting as acute cerebral. Sphenoid wing also called sphenoid ridge problems with vision, loss of sensation in the face, or facial numbness, and seizures. If the inline pdf is not rendering correctly, you can download the pdf file here. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose.
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. Surgical management of medial sphenoid wing meningiomas is challenging because of the closely. Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. The very challenging surgical considerations of clinoid meningiomas.
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. An osteolytic meningioma en plaque of the sphenoid ridge article pdf available in journal of korean neurosurgical society 431. More difficult was the total removal of meningiomas of the inner third or of the entire sphenoid ridge 47%. Here, we describe an unusual case with clusterlike headache 2. Medially, this tumor may expand into the wall of the cavernous sinus, anteriorly into the orbit, and laterally into the temporal bone. Sphenoid wing meningiomas are notoriously difficult tumors to manage due to their location and proximity to vital structures the optic nerve, superior orbital. Meningioma en plaque of the sphenoid ridge en plaque meningiomas characteristically lead to slowly increasing proptosis with the eye angled downward.
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. Furthermore, medial clinoidal meningiomas are further differentiated into 3 subcategories based on their relation to the anterior clinoidal process. Mar, 2020 a medial sphenoid wing meningioma with minimal medial extension is shown upper images. Yang j, ma sc, liu yh, wei l, zhang cy, qi jf, et al. The rate of recurrence for medial sphenoid wing meningiomas is reported as. It originates from the arachnoidnot the dura, the tissue covering the brain and spinal cordlying deep to the dura. Sphenoidal ridge meningiomas originate from this sharp limit separating the subfrontal region from the temporal fossa.
Sphenoid ridge meningioma manifesting as subarachnoid hemorrhage korean j radiol 9suppl, july 2008 s finding. Typical, atypical, and misleading features in meningioma. 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. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. 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. The purpose of this study is to present our results of. These tumors can cause visual problems, loss of sensation in the face, or facial numbness.
Sphenoid wing meningiomas are the second most common meningiomas after the parasagittal subtype. In 1938, cushing and eisenhardt reported the first surgical experience with meningiomas of the sphenoid ridge. A benign sphenoid ridge meningioma manifesting as a. Dec 18, 2019 benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. For example, a parasagittal meningioma is located near the sagittal sinus, a major blood vessel at the top of the cerebral hemispheres. 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. The sylvian middle cerebral artery branches drape over the superior pole of the tumor. 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. Sometimes, people with meningioma do not have any of these changes. Benign sphenoid wing meningioma presenting with an acute intracerebral hemorrhage a case report. Here, the authors report a case of sphenoid ridge meningioma presenting with acute cerebral infarction caused by middle cerebral artery mca compression.
Pdf an osteolytic meningioma en plaque of the sphenoid ridge. Clusterlike headache secondary to anamnesis of sphenoid. Cerebral angiography demonstrated complete occlusion of. 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. Outcome of medial sphenoidal wing meningioma surgery. Or, the cause of a symptom may be a different medical condition that is not a. This article is a general discussion of meningioma focusing on typical primary intradural meningiomas and the imaging findings of intracranial disease. They are frequently located along the falx, convexity, and the sphenoid ridge. 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.
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