Cureus bony hyperostosis recurrence after complete. Sphenoidal meningiomas constitute 18% of intracranial masses. Hyperostosis and secondary bone formation at the origin of the tumor in the region of the anterior clinoidal process are indicated by arrowheads. The cases we present do not estimate the real prevalence of meningiomas localizations.
Bone involvement was compared in 12 corresponding ct and mr studies of 10 female patients with sphenoid wing meningiomas recurrence after. A considerable amount of hyperostosis is the hallmark, and usually causes proptosis, optic nerve compression, and diplopia. Case report a 47 years old woman with right sphenoid ridge tumor was operated in 2003. Pdf hyperostotic sphenoid wing meningioma en plaque. Case report ectopic sphenoid sinus meningioma with huge hyperostosis. Sh meningioma, also known as meningioma en plaque of the sphenoid wing, usually arises from. Sphenoid wing meningiomas still present a difficult surgical challenge especially when they are large in size and involve neurovascular structures. The cause, management, and prognosis of these bony changes have long been a point of controversy. Does bony hyperostosis in intracranial meningioma signify. Hyperostotic sphenoid wing meningioma en plaque romanian. They are a nonglial neoplasm that originates from the meningocytes or arachnoid cap cells of the meninges and are located anywhere that meninges are found, and in some places where only rest cells are presumed to be located. Management of boneinvasive, hyperostotic sphenoid wing. Amirjamshidi a, abbasioun k, amiri rs, ardalan a, ramak hashemi sm. In all patients, hyperostosis was determined on the basis of preoperative neuroimaging.
Figure 322 large medial sphenoid wing meningioma a, mr appearance of a large meningioma of the right medial sphenoid wing upper panel. Methods bone involvement was compared in 12 corresponding ct and mr studies of 10 female patients with sphenoid wing meningiomas recurrence after earlier surgical treatment. Hyperostosis associated with intracranial meningiomas is a welldescribed entity. Purpose we used mr imaging to analyze retrospectively the pattern of hyperostosis occurring concomitantly with recurrent sphenoid wing meningiomas.
Especially, atypical meningioma is rare but existed among meps. Background sphenoorbital meningiomas are complex tumors that arise in the dura of the sphenoid wing. The hyperostosis is sometimes argued to be a reactive phenomenon. Sphenoid wing en plaque meningiomas are a subgroup of meningiomas defined by its particular sheetlike dural involvement and its disproportionately large bone hyperostosis. 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. B ct scans demonstrating extensive hyperostosis centered within the right sphenoid involving the greater and lesser right sphenoid wings as well as the orbital, frontal, and zygoma bones.
The aim of the study is to shed light on the management of sphenoid wing meningioma, study the outcome of. Drilling is continued extradurally to unroof the optic canal and disconnect the optic strut, allowing. Sphenoid wing en plaque meningiomas are also called sphenoorbital meningiomas and pterioneal meningiomas en plaque. En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas, characterized by a.
Chapter 58 recurrence of meningiomas and its management. Rates of recurrence for sphenoorbital meningioma depend on the extent of. However, the vast majority have a typical appearance, as in this case with avid homogenous enhancement and a dural tail. Extracranial extension of intracranial atypical meningioma. Sphenoid wing meningiomas are notoriously difficult tumors to manage due to their. However, such hyperostosis of the temporal andor sphenoid bone is rarely discussed in the available literature, especially in the absence of meningioma. Current approach to meningiomas of the medial sphenoid. Sphenoorbital meningioma, also known as meningioma en plaque of the sphenoid wing, usually arises from the lesser wing of the sphenoid bone, is often associated with bony hyperostosis, and may invade the frontal, middle cranial base, orbit, and nasal sinuses.
Description of surgical strategy and analysis of findings in a series of 88 patients with longterm follow up. Indications and preoperative considerations meningiomas are one of the most frequently occurring intracranial primary tumors. During the surgery, a piece of bone was sent for pathological evaluation. En plaque meningiomas of the sphenoid wing were excluded from the study because they mostly extend along the entire sphenoid wing and do not have a delimited area of dural attachment. This term was given by cushing to differentiate them from the commonest form, also called meningioma en masse.
Total surgical resection is difficult and therefore these tumors have high recurrence rates. This is an example of a case of left frontal convexity meningioma, which reveals hyperostosis of the overlying bone. Outcomes of surgical treatment and radiation therapy in en. For small medial sphenoid wing meningiomas a supraorbital craniotomy or a.
Original article surgical management of sphenoid wing. 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. The sphenoid wing is the most common location of meningioma en plaque. Preoperative and postoperative views of a 59yearold woman who was diagnosed as having sphenoid wing meningioma after presenting with incidental proptosis. Meningiomas of the skull base pdf free download ebook description meningiomas, the second most frequent of intracranial tumors, are characterized by a protean range of possible locations and appearances, due to their origin from the. Those are anatomically located along the sphenoid ridge, the bony crest formed by the greater and lesser sphenoid wings. Case report hyperostosis of the frontal, temporal, and. Contrast ct head c showing abundant hyperostosis of the temporal bone and the lateral sphenoid wing. Meningioma causing hyperostosis of the cranial convexity. They are characterized by hyperostosis of the sphenoid bone.
Meningiomas involving the optic canal 3 bination of both. There is increased bone formation and mineralization in this region likely from hyperostosis due to a known meningioma. Typical localizations of meningioma include the convexity, parasagittal, the sphenoid wing, the olfactory groove and the parasellar region. There were 108 medial sphenoid wing meningiomas of globoid shape. Diverse imaging appearances and locations of meningioma. Among 108 medial sphenoid wing meningiomas, there were 81 women 75% and 27 men 25%. We report a case of hyperostosis of the frontal, temporal, and sphenoid bones. Meningioma en plaque is most commonly seen in the sphenoid wing, although they have been described in a number of locations. Hyperostosis is a wellknown sign of meningiomas, which is observed in 4.
Sphenoid wing meningiomas swms represent up to 18% of intracranial meningiomas. Bone hyperostosis is much more extensive and is responsible for clinical. The intracranial portion of the tumor is usually thin with en plaque spread, and the tumor tends to invade the orbit through the superior orbital fissure. In all reported series of sphenoid wing meningiomas, histopathologic examinations revealed high incireceived august 21, 1992. Hyperostosis associated with meningioma of the cranial. After the coz osteotomy is completed, the microscope is introduced and the remainder of the sphenoid ridge is drilled away, opening the superior orbital fissure.
Sphenoid wing meningiomas are also known as orbitosphenoid meningiomas, meningiomas en plaque of the sphenoid wing, and sphenoid wing meningiomas with osseous involvement. Transorbital endoscopic eyelid approach for resection of. Original article outcome of sphenoid wing en plaque. We did not include patients with nonhyperostotic sphenoid wing meningiomas, hyperostotic sphenoid wing meningiomas with a moderate or large. 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 results and outcome of sphenoid wing en plaque. They may be multiple and a wide range of potential imaging appearances are possible. Case report ectopic sphenoid sinus meningioma with huge. Some authors have postulated that hyperostotic changes are secondary to the formation of the tumor and do not constitute invasion of the tumor into the bone. The bony hyperostosis is of neoplastic nature and is responsible for many. Although bone hyperostosis is a well known feature in all types of meningiomas, in this particular type of tumor the bone invasion is much more. Total surgical resection is difficult and therefore these tumors have high. Medial sphenoid wing meningioma approximately 1520% of all meningiomas arise from the sphenoid wing, with about half of these arising from the medial portion of the wing. Surgical management of skull base meningiomas an overview.
Exclusion criteria consisted of clinoidal meningiomas, optic nerve sheath meningiomas, cavernous sinus meningiomas with intraorbital extension and non hyperostosis or en mass sphenoid wing. Sphenoid wing en plaque meningiomas are also called sphenoorbital meningiomas. En plaque meningiomas represent 29% of all meningiomas and they are mainly located in the sphenoid wing. Meningiomas most frequent locations are variable, depending on different series. The present case, as suspected by imaging, may be the first report of a rare intraosseus meningioma of sphenoid wing in bangladesh. For sphenoid wing meningiomas, the incidence of hyperostosis reaches 90% and more 4, 6, 11. Lateral orbitotomy approach for removing hyperostosing en.
Recurrence of meningiomas and its management clinical gate. Hyperostosis of the skull differential dr daniel j bell. Meningiomas are extraaxial tumors and represent the most common tumor of the meninges. Differential diagnosis includes fibrous dysplasia, osteoma, and metastasis. Sphenoid wing meningiomas exhibit a very high incidence of hyperostosis, which can be observed in up to 90% of cases. The hyperostosis frequently associated with sphenoid wing meningiomas is actual invasion of bone by the tumor. En plaque sphenoid wing meningioma is morphological unique in comparison with other intracranial meningiomas. As most of the hyperostotic and obvious tumourinfiltrated bone material was. This is a case of left lateral sphenoid wing meningioma, in which the overlying bone does not show any thickening.
Medial sphenoid wing meningiomas are a heterogeneous group of tumors originating from the anterior clinoid and the medial third of the lesser sphenoid wing. Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are characterized by the associated bony hyperostosis that gives them a distinct radiological appearance. Exophthalmus may be due to bony hyperostosis, orbital invasion by the meningioma, or cavernous sinus involvement. The tumour is typically slow growing, of limited thickness and has a flat or slightly nodular shape. Seventeen of the patients had the distinguishing characteristics of hyperostotic sphenoid wing meningiomas extensive bone invasion, en plaque dural involvement, and a minimal intracranial mass with minimal orbital involvement. Lateral orbitotomy approach for removing hyperostosing en plaque sphenoid wing meningiomas. Reconstruction after resection of sphenoid wing meningiomas. Hyperostosis of the internal table of the frontal bone is not an uncommon phenomenon. Four of these had histologically confirmed meningiomatous infiltration of.
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