of a sphenoid wing meningioma The patient is a 36-year-old female with mild obesity and a history of hyperthyroidism, which was treated with propylthiouracil. Dural Fistula Protecting Nearby Adamkiewicz. In my opinion, surgical classification should . [ 67 , 72 ] 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. They may grow into the orbit. The types of symptoms that patients with meningiomas experience include seizures, headaches, muscle weakness, confusion, changes in personality, visual disorders and hearing loss. Last Update: May 30, 2022 . Background . [5,30] Using microsurgical techniques via the arachnoidal plane allows . Treatment for meningioma About eight out of 10 meningiomas can be cured. A relatively common neoplasm of the CENTRAL NERVOUS SYSTEM that arises from arachnoidal cells. Radiation therapy may cause an acute adverse effect such as brain edema, radiation necrosis, or delayed, for example, panhypopituitarism, vasculitis, and rare de-novo neoplasm development. Her symptoms started one week after completing radiotherapy. They can cause loss of smell and grow large enough to affect vision. Spinal Dural Fistula PSA DYNA identification radial. Sphenoid wing meningiomas are slow growing tumors that originate from outer arachnoid meningeal epithelial cells. Treatment Incidental meningiomas with no brain edema or those presenting only with minimal symptoms that can be easily controlled with medications could be observed with periodic MRI imaging as meningiomas tend to grow slowly . The binding will be tight and all of the pages are still attached. This mass compresses and displaces the optic . Lesions were classified based on the following locations: the sphenoid ridge, the calvarial . 4). They account for 11% to 18% of cases in large surgical series.1-6 Presumably radiation-induced sphenoid meniningiomas have been described.7,8 Jacobs and co-workers have reported a nonrandom association between . Due to their location, certain types of meningiomas (convexity, parasagittal, and lateral sphenoid wing) usually are . Grade I is the most common type of meningioma and is considered benign. En plaque meningiomas represent 2-9% of all meningiomas and they are mainly located in the sphenoid wing. The medial group carries the highest neurologic risk for surgical treatment, while The complete search strategy can be found . Surgical treatment may be necessary for symptomatic, growing tumors. However, radiation-induced meningioma (RIM) occurrence is extremely rare. It is a type of anterior skull base meningioma. The treatment of meningiomas involving the cavernous sinus (CS) has improved markedly due to anatomical knowledge of the structures in and around the CS, and advances in surgical techniques. Meningiomas are the most common non-glial intracranial tumors in adults, which account for 14-19 % of all primary intracranial tumors and occur most commonly in females. In the present series, the bone component was located by definition in the great sphenoid wing in all patients, therefore involving the . the treatment is often microscopic resection or radiosurgery with radiation to reduce recurrence rates. Surgical resection is the mainstay of treatment for medial sphenoid wing meningiomas. The clinical materials of 65 patients with . Often, meningiomas cause no symptoms and require no immediate treatment. Figure 3 is a 3D volumetric reconstruction of a patient after orbitozygomatic approach resection of a sphenoid wing meningioma. A: If we have a book listed as "New", then that book is exactly that, NEW. Monday - Spinal Shunts. We report a case of a 43-year-old woman with an underlying right sphenoid wing meningioma (SWM) who complained of increased right eye swelling, proptosis, redness and severe pain for two weeks. Surgical resection of sphenoid wing EPM is especially challenging as the tumour tends to invade the cavernous sinus, and/or the orbit, and their neurovascular structures. They originate from arachnoid cap cells, which are cells within the thin, spider web-like membrane that covers the brain and spinal cord. Sphenoid wing meningiomas are the most common of the basal meningiomas. [4] [6] Genetically, the most well characterized and common alteration is the loss of the NF2 gene (NF2) on chromosome 22q. Pathogenesis. A recurrence risk approaching 30% has been reported when incomplete removal is attempted. If it is used it will be described as "Good". 3,4 Asymptomatic patients diagnosed by . The following guide outlines the meningioma grading system: Grade I (benign). 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. Aim To evaluate computed tomography (CT) and magnetic resonance imaging (MRI) findings of cranial intraosseous meningiomas (IOMs). However, the surgical approach to meningiomas in this . Sphenoid wing meningiomas (SWMs) . Missed dural fistula x 3 technique. Methods A retrospective case analysis was performed in 67 patients (53 of whom were female) harboring meningiomas en plaque originating from the sphenoid wing, who underwent surgery between 1991 and 2002. Surgical excision is the treatment of choice for accessible intracranial meningiomas. From a surgical standpoint there are three distinct groups: (1) globoid, medial SWMNG; (2) globoid, middle/lateral SWMNG and; (3) hyperostosing SWMNG. These meningiomas can cause visual problems and facial numbness. It accounts for 2-9% of all meningiomas. Sphenoid wing meningiomas form in the skull base behind the eyes. Meningiomas that arise from the dura along the sphenoid wing can occur in globoid or en plaque forms. Meningioma treatment includes observation of its growth or surgery with or without associated radiotherapy. Prior to the diagnosis of sphenoid wing meningioma, the patient reported the follow ing symptoms to her physician: sudden onset of severe headache with nausea and vomiting. In case of high-risk patients or recurrence, however, stereotactic radiosurgery is a valuable option []. Medially, this tumor may expand into the wall of the cavernous sinus . These are more difficult to remove surgically than convexity meningiomas. Bowers CA, Sorour M, Patel BC, Couldwell WT. Signs and symptoms of a meningioma typically begin gradually and may be very subtle at first. The tumor often encases the internal carotid artery and proximal middle and anterior cerebral artery as well as the optic nerve and may compress or provoke edema in the temporal or . In this analysis we evaluate the outcome of . Grade III is the most aggressive form and is considered malignant. Due to the complex structure of the cranial base and its close proximity to critical structures, surgery is often associated with substantial morbidity. Approximately 20 percent of meningiomas are sphenoid wing. The tumor has filled the area where the temporal lobe normally lies. Medially, they may expand into the wall of the cavernous sinus, anteriorly into the orbit, and laterally into the temporal bone. Hyperostosing sphenoid wing meningiomas. Pterional or lateral SWMs arise from the dura covering the outer sphenoid wing. SOM that involve the medial portion of the sphenoid wing represent more challenging lesions due to the involvement of the neurovascular structures, but there is an arachnoidal plane between the neurovascular structures and the medial portion of the sphenoid wing meningioma. The arachnoid is one of three protective layers, collectively known as the meninges, which surround the brain and the spinal cord. From a surgical standpoint there are three distinct groups: (1) globoid, medial SWMNG; (2) globoid, middle/lateral SWMNG and; (3) hyperostosing SWMNG. J Neurosurg. . Examples of tumor effects associated with . The British journal of ophthalmology 2011;95:996-1000. Sphenoid wing meningiomas They originate from the lining that covers the lateral aspect of the sphenoid bone, located just deep to the temple and behind the eye. To review the role of craniofacial resection and reconstruction in the treatment of patients with sphenoid wing meningioma en plaque. Continue Reading. through the length of the small wing of the sphenoid, part of the large wing of the sphenoid, especially near the superior orbital . Sometimes meningiomas cause little or no symptoms and are discovered during a scan carried out for other reasons. Spinal Dural Fistula Embolization Adjacent to anterior and posterior spinal arteries. Certain features classically associated with meningiomas include psammoma bodies, whorl formations, and nuclear pseudoinclusions. Sphenoid Wing Meningiomas The classification of these tumors as shown below is most practical: . Meningiomas are much more common in females, and are more common after 50 years of age. A meningioma is a benign brain tumor. This treatment is indicated considering the following factors: size of the lesion, presence of signs or symptoms, patient's condition, changes in the adjacent cerebral tissue (edema) on imaging studies, and surgeon's experience. Their encapsulated, slow growth makes meningiomas good targets for radiosurgery.In one series, less than one-third of clinoidal meningiomas could be completely resected without unacceptable risk of damaging of blood vessels . Meningiomas are neoplasms arising from arachnoid cap cells in the meninges. Since the vast majority of meningiomas are benign (noncancerous), they are most commonly treated with surgery. Sphenoidal meningiomas constitute 18% of intracranial masses, and still present a difficult surgical challenge. Meningiomas. Meningiomas are much more common in females, and are more common after 50 years of age. The sphenoid wing is a common location for clinically symptomatic meningiomas that require treatment. Gamma knife radiation and microscopic surgery are common options. by Preeti Thyparampil, MD on March 22, 2022. Well-defined enhancing 4.8 cm mass centered on the right wing of sphenoid with a significant component of this within the infratemporal fossa. The histologic appearance is characteristic. As to whether a meningioma found in these circumstances needs treatment or simply follow-up with scans can depend on the size, location, and other scan features of the tumour. Rear of the brain (occipital lobe) - loss of half of the field of vision in one eye (contralateral hemianopsia). In some cases, deletions involving chromosome 22 are involved. Headaches, especially those that are worse in the morning. The M2 segment of the MCA abuts the mass medially. Sphenoid wing meningiomas can be divided into three main groups: 1) meningiomas arising from the anterior clinoid and medial third of the sphenoid wing, 2) meningiomas arising from the middle and lateral sphenoid wing, and 3) en plaque meningiomas of the sphenoid wing or spheno-orbital meningiomas. Case Discussion. 16 were observed without treatment for a mean of 10.2 years from onset of symptoms Skull-base meningiomas form in the bones in the bottom of the skull or in the boney ridge behind the eyes. Stereotactic radiosurgery is an option for asymptomatic small tumors without mass effect, but the proximity of highly radiosensitive optic chiasm and nerves often precludes its use. Sphenoid wing meningiomas are tumors that typically present with vision deterioration and neurological changes due to their proximity to the sella, cavernous sinus, and other vital structures. Radiation therapy is widely used as adjuvant or primary treatment modality of neoplastic lesions. . Surgical treatment of sphenoorbital meningiomas. Total microsurgical resection of sphenoid wing meningioma is usually curative. Sphenoorbital meningioma: surgical technique and . The patient's findings were consistent with a left sphenoid wing meningioma. The sphenoid ridge separates the anterior from the middle cranial fossa and is related to the sphenoid segment of the sylvian fissure and the M1 segment of the middle cerebral artery. Surgical treatment of sphenoorbital meningiomas. In general, surgery is indicated in all patients who are in good health and . [ 58, 84] Depending on the bony involvement and the soft tissue component of the tumor, the principles of resecting a sphenoid wing en plaque meningioma are complete removal of . PTBE has been associated with several complications and future recurrence. . . It originates from the dura mater, the tissue enwrapping the brain and spinal cord. Sphenoid wing meningiomas are also known as "orbitosphenoid meningiomas," "meningiomas en plaque of the sphenoid wing," and "sphenoid wing meningiomas with osseous involvement." . Axial (A) and coronal (B) CT scans show typical hyperostosis of the greater wing of sphenoid bone and involving adjacent temporal bone, the edge of hyperostosis is rough and brush-like (arrow).T1-weighted MRI (C) scan with gadolinium shows enhancement of the dura in the left anterior temporal area (arrow) and periorbita, the . Where is sphenoid wing? Hence, meningiomas of the lateral sphenoid wing are often . These intracranial meningioma s 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. Meningioma Ethmoido-sphenoidal 1 NS TPHD 5 9 M 47 22.5 Chondrosarcoma Sphenoid wing 1 NS + RT TPHD 20 10 F 38 23.0 Osteosarcoma Clinoid 1 NS + RT + CT TPHD NA 11 F 69 25.3 Meningioma NA NA NS + RT TPHD 10 Hyperpolactinemia 12 M 42 31.4 Anaplastic astrocytoma Frontal 2 NS + RT + CT 2016 Sep. 125 (3):544-50. Spinal meningiomas are less common than other types of skull base meningiomas and . Among 42 patients with unilateral optic nerve sheath meningiomas treated at Massachussets Eye and Ear Infirmary from 1973 to 1999. Surgical treatment of sphenoorbital meningiomas. These tumors often invade important neurovascular structures around the orbital apex, superior orbital fissure, and cavernous sinus. Cavernous sinus meningioma s (CSMs) occur in 0.5 per 100,000 persons in the general population. They cause neurological compromises by direct compression of adjacent cranial nerves. A meningioma is a benign brain tumor. It exerts a compressive effect on the adjacent skull foramina as compression on the optic nerve. Sphenoid wing meningioma. The search strategy included terms for meningioma, sphenoid wing and spheno-orbital, and derivatives or synonyms of these words. Treatment depends on the location, type and size of . Download Free PDF. Total removal of a meningioma is preferred since it lessens the chances of the tumor returning. The standard surgical approach consisted of . The sphenoid wing is a common location for clinically symptomatic meningiomas that require treatment. 8.2 Lateral or Pterional Sphenoid Wing Meningiomas 8.2.1 General Aspects and Clinical Presentation. Meningiomas are the most common benign intracranial tumor. En-plaque-meningioma (EPM) is characterized by its flat growth along the bony contour. This study aims to evaluate the outcome of the operatively treated sphenoid wing meningiomas in relation to PTBE as a prognostic factor in a series of 65 patients. 2011, British Journal of Ophthalmology. Meningioma grading (I to III) is based on the appearance of the tumor cells under a microscope. Irvette Marte, get her life back after receiving treatment at Mount Sinai. Sphenoid wing meningiomas (SWM) are known to present with intraosseous growth in a higher percentage than meningiomas in other locations. Expert Answers: Sphenoid wing meningioma forms on the skull base behind the eyes. Following apparently complete removal of benign meningiomas the reported control rates are in the region of 95% at 5 years, 90% at 10 years and 70% at 15 years [1-10].However, meningiomas located in the region of the base of skull are often difficult to access and only subtotal or partial resection is . Sphenoid wing meningiomas, also known as sphenoid ridge meningiomas, are the most common of the basal meningiomas. It is important to differentiate arrested pneumatization of the sphenoid sinus from lesions, such as arachnoid granulations, acoustic neuroma, glioma, metastatic lesions, meningioma, or chordoma, to prevent unnecessary biopsies or exploratory surgeries that would consequently reduce treatment costs and alleviate anxiety in patients. Meningiomas have a predilection to arise from the parasagittal region . In this paper we discuss the theories of cellular origin as well as the radiologic differential diagnosis 10) 1) Kirollos RW. . Of all cranial meningiomas, about 20% of them are in the sphenoid wing. Sphenoid wing meningiomas are the most common intracranial tumors that can directly extend to the orbit. Meningioma is a common benign intracranial tumor.1 Approximately 11% through 20% of all meningiomas originate from the arachnoid cap cells and are attached to the meninges along the wing of the sphenoid bone, and approximately one-half arise from the medial aspect.2 Sphenoid ridge meningiomas constitute approximately 20% of supratentorial . Total surgical resection is difficult and therefore these tumors have high recurrence . An intraventricular meningioma may cause a blockage of CSF flow, leading to hydrocephalus. (left) MRI scan of a sphenoid wing meningioma. Figure 2. Radiographic studies of a left sphenoid wing meningioma en plaque. There are generally three treatment options for meningiomas: Observation - If a meningioma is small and asymptomatic in a person over 65, it may just be observed. . This is called an incidental finding. Headache and psychological deficit represent the most common clinical presentation due to the fact that they are slowly growing tumors and their diagnosis is often delayed until they reach quite a large size. Observation without treatment is appropriate in some cases to confirm that the visual loss is progressive before intervening. Histologically, meningiomas arise from the leptomeninges, specifically from arachnoid cap cells. Orbital Meningiomas. sphenoid wing), as secondary orbital meningiomas. (right) The illustration shows that as the tumor grows, it compresses and displaces normal brain tissue and can encase the arteries and nerves. Olfactory groove meningiomas form along the nerves that run between the brain and the nose. . In severe cases, they can cause blindness. Surgical treatment may be necessary for symptomatic, growing tumors. optic nerve sheath) or extend into the orbit from intracranial structures (ie. In the past, these tumors always required a traditional . Observation requires annual CT or MRI scans with contrast. The mass extends through the superior and inferior orbital fissures into the intra and extra-conal spaces. CHAPTER 32 Sphenoid Wing Meningiomas Matthias Simon, Johannes Schramm INTRODUCTION Meningiomas arising in the sphenoid region are frequently encountered in neurosurgical practice. Sphenoid wing meningiomas form on the sphenoid ridge behind the eyes. Dural Fistula Returning Veins to Cord. Sphenoid wing meningiomas are categorized as lateral, middle, or medial (clinoidal), depending on the origin of the tumor along the sphenoid . Treatment of sphenoid wing meningiomas often depends on the location and the size of the tumor. Sphenoid wing meningioma forms on the skull base behind the . . Depending on where in the brain or, rarely, spine the tumor is situated, signs and symptoms may include: Changes in vision, such as seeing double or blurriness. Outcomes after surgical treatment of meningioma-associated proptosis. It originates from the arachnoid (not the dura), the tissue covering the brain and spinal cord lying deep to the dura. Treatment. tumour and treatment characteristics: the institution, study period, number of patients, age and sex, definition used for hyperostotic SOMs, other tumour location in case . Among sphenoid wing meningiomas, 59% are osteoblastic, 10%-35% are osteolytic, and 6% are a mixed picture of both osteolytic and hyperostosis. The presenting features, operative . The optimal treatment for the great majority of symptomatic or growing meningiomas is maximal safe surgical removal. sphenoid wing meningioma, surgical treatment, molecular study, stereotactic radiotherapy Abstract. Meningiomas make up 95% of benign brain tumors, but 15%-19% of meningiomas involve the greater sphenoid wing and are also known as "orbitosphenoid meningioma," "meningioma en plaque of the sphenoid wing," and "sphenoid wing meningioma with osseous involvement." Sometimes radiation can help reduce the size of a meningioma. However, drug treatment can be used for tumors deemed inoperable because of their size and location. Whether used as a primary, adjuvant, or salvage procedure, SRS is a safe, less invasive, and effective modality of treatment as microsurgery. . Treatment options vary with close follow-up and periodic imaging often advocated for 20/40 vision or better. When planning the surgical treatment of an en plaque meningioma of the sphenoid wing, the extension of both tumor components - dural/intradural and bone involvement - have to be taken in consideration . Radiation may also be considered to treat small remainders of the tumor after . Radiographically they can be defined as occurring in the medial, middle, or lateral portions of the sphenoid wing.
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