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. [22] These lesions can be divided into medial, middle, and lateral sphenoid wing meningiomas. Tumors located here can become involved with the visual nerves or surround a key artery. Surgical treatment of sphenoorbital meningiomas. Figure 3 is a 3D volumetric reconstruction of a patient after orbitozygomatic approach resection of a sphenoid wing meningioma. Background and Study Object We report an unusual case of a benign lateral sphenoid wing meningioma that presented with, and was masked by, an acute intracerebral hemorrhage. The tumor could be completely removed. Its lateral end joins the frontal, parietal, and temporal bone. Contents 1 Pathogenesis 2 Diagnosis 2.1 Classification 3 Treatment 4 Prognosis 5 References Pathogenesis [ edit] A meningioma is a benign brain tumor. Sphenoid ridge meningiomas represent approximately 20% of supratentorial meningiomas, among which less than half arise from the medial ridge of the sphenoid. Book Chapter Pirotte B.J.M., Brotchi J. More common symptoms of brain meningiomas include: Headaches. The types of symptoms that patients with meningiomas experience include seizures, headaches, muscle weakness, confusion, changes in personality, visual disorders and hearing loss. Once the muscle is elevated and reflected anteriorly, lateral sphenoid wing hyperostosis is usually apparent, and any noticed during elevation of the temporal muscle is excised. Surgical treatment of sphenoorbital meningiomas. 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. the greater wing constituting the outer third and the lesser wing the inner two thirds. 2-7 Keywords Cavernous Sinus Pituitary Stalk 4 this anatomic portion is also known as the sphenoid ridge, where the lesser wing constitutes its internal two thirds and the A 30-year-old female patient presented to the Emergency Department (ED) with a six-week history of right eye pain, diplopia on lateral gaze, and proptosis. Resection of tumor close to these structures should be carried out with caution. Tumors found in the external third of the sphenoid are of two types: en-plaque and globoid meningiomas. Signs and symptoms of a meningioma typically begin gradually and may be very subtle at first. Two cases are presented with incidental findings. Types Tumors found in the external third of the sphenoid are of two types: en-plaque and globoid meningiomas. colon adenocarcinoma (status post resection); recent surgery for right sphenoid wing meningioma: left transverse (lateral) sinus: A meningioma is a benign brain tumor. can present anywhere on venous sinuses and thus Sx may differ. GLOBOID MENINGIOMAS (1) deep, inner, or clinoidal (2) middle or alar (3) lateral, outer, or pterional. FIGURE 32-1 Large lateral sphenoid wing (pterional) meningioma. It originates from the dura mater, the tissue enwrapping the brain and spinal cord. Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes. 10. Although extended lateral orbitotomy through a lid-crease incision has been used, the various approaches to the supero-posterior orbit and anterior cranial fossa often involve a craniotomy. Sphenoid wing meningiomas are the most common intracranial tumors that can directly extend to the orbit. While brain retraction can enable access, its use can have potentially deleterious effects. The aim of this report is to define cone beam computed tomography (CBCT) characteristics of arrested pneumatization of sphenoid sinus in an effort to help differentiate it from invasive or lytic skull base lesions. Meningioma NOS. Adequate surgical exposure with minimal morbidity is a challenge for those treating these lateral skull base lesions. . Sphenoid wing meningioma forms on the skull base behind the eyes. Sphenoid meningiomas: grow along the bony ridge behind the eyes. The sphenoid wing has been drilled and seen as much as possible. Case Discussion. The sphenoid bone forms the central skull base and viewed anteriorly resembles a bird with its wings unfurled. Lukas Stalpers. This type of tumor can cause a loss of smell, and can grow large enough to cause . These tumors can cause visual problems, loss of sensation in the face, or facial numbness. The optimal treatment for the great majority of symptomatic or growing meningiomas is maximal safe surgical removal. Sphenoid meningiomas (meningiomas growing on the optic nerve behind the eyes) can cause visual problems, including loss of patches within your field of vision, or even blindness. We report the benefits and outcomes of the criteria we have developed for use of . Applicable To. NF2 encodes a tumor suppressor known as merlin. On MRI it is isointense on both T1 and T2 images to grey matter, and again demonstrates enhancement. .pdf 560.43K In addition, they can cause loss of sensation in the face, or facial numbness. 1, 2 the incidence of hyperostosis in sphenoid wing meningiomas approaches 90%, 3, 4 and histopathologic studies have revealed that the hyperostosis OA - thickening of . Abstract Background: Sphenoid wing meningiomas are slow-growing, well-circumscribed, and histologically benign lesions. A Biblioteca Virtual em Sade uma colecao de fontes de informacao cientfica e tcnica em sade organizada e armazenada em formato eletrnico nos pases da Regio Latino-Americana e do Caribe, acessveis de forma universal na Internet de modo compatvel com as bases internacionais. Hence, meningiomas of the lateral sphenoid wing are often . The recurrence rate is low if removed completely at the time of surgery. This is the American ICD-10-CM version of D32.9 - other international versions of ICD-10 D32.9 may differ. Haematological and biochemical results were all normal. Of these, about one half occur in the sphenoid wing.1-3 Sphenoid wing meningiomas then account for more or less 20% of intra-cranial meningiomas. 2011, British Journal of Ophthalmology. Meningiomas may originate in unexpected locations such as the orbit, paranasal sinus, or ventricles or be entirely intraosseous (within the calvaria). Meningioma . well demarcated, grey tum, sphenoid bone, close to venous sinus = meningioma. Preoperative embolization of the . 1 these tumors arise from arachnoid cells of the perineural sheaths or the arachnoid layer of the meninges. She had reported progressive onset of symptoms over the past 12 months. The first surgical experience with meningiomas of the sphenoid ridge was reported in 1938 by Cushing and Eisenhardt. also occur in sarcoidosis, neurofibroma, arachnoidal cyst, and chronic hydrocephalus. . Case Report A 68-year-old woman was admitted after sudden onset of coma . Hearing loss. It is a compound bone with a median body and paired lateral greater and lesser wings ( Fig. 90 percent of meningiomas are categorized as benign tumors, with the remaining 10 percent being atypical or malignant. The second-most-common intracranial location for meningiomas is the sphenoid ridge. epitheloid cells in rounded clusters. Small meningiomas and those without symptoms can be observed with periodic MRI imaging to monitor tumor growth. En plaque meningiomas characteristically lead to slowly increasing proptosis with the eye angled downward. Intraosseous meningioma of the sphenoid bone Some sphenoid wing meningioma s are associated with a significant hyperostosis of the adjacent sphenoid ridge that may even exceed the size of the intradural mass. Meningioma Metastasis. Both studies, acquired for other diagnostic purposes . In some cases, deletions involving chromosome 22 are involved. cavernous sinus, or carotid arteries) as well as the cranial nerves, making them difficult to completely remove. Seizures. It originates from the arachnoid (not the dura), the tissue covering the brain and spinal cord lying deep to the dura. Imaging Findings Meningiomas are much more common in females, and are more common after 50 years of age. Aphasia is usually the consequence of left lateral sinus (LS) and tributaries cortical veins thrombosis from the dominant hemisphere. The decision-making process and surgical planning based on neuroanatomic knowledge are the mainstays of management of this group of lesions. Diagnosis Standard x-rays are often valuable in detecting meningiomas. Basilar Thrombectomy via Posterior Communicating Artery. This landmark is called the pterion. Those. meningioma. Nausea and vomiting. Sphenoid Wing Meningioma is a tumor that arises on the meninges covering the bone on the side of the skull base. A meningioma is a noncancerous and slow-growing tumor that develops in the covering of the brain (meninges). 1). The thicker lateral orbital wall is composed of the zygomatic bone and the greater wing of the sphenoid bone. Surgical microscope was brought into the field, initially starting in the temporal area. The tumor was diagnosed in a 67-year-old female patient who presented with flattened affect, cognitive decline, a possible seizure, and a mild hemiparesis. We removed the hematoma and resected the tumor completely in the same session. MR imaging showed a large sphenoid wing tumor invading the brain with the involvement of lateral wall of the cavernous 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. Lateral sphenoid wing meningiomas arise from the pterion and typically grow along the Sylvian fissure. The dura was elevated and was connected to surrounding drapes. Common clinical presentation of CNS tumors is, . The histopathological classification of the tumor was a WHO grade I meningothelial meningioma. lNTRODUCTlON. The lateral wall extends anteriorly to the equator of the globe, allowing for a temporal field of vision. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone . [5,30] Using microsurgical techniques via the arachnoidal plane allows . Those that have grown to a very large size, encasing the major cerebral arteries, are associated with a high risk of stroke. Case 2: Middle and medial sphenoid wing meningioma with brain invasion This 53-year old woman presented with severe headaches and blurred vision in the right eye for the last 6 months. Olfactory groove meningioma forms along the nerves that run between the brain and the nose and account for around 10 percent of meningiomas. 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. One is globular, and a tumor showing this type of growth is, from a surgical standpoint, a low convexity meningioma, which is not . 3.1 ). 3) Lateral sphenoid wing meningioma or pterional meningioma. Arrested pneumatization of the sphenoid sinus is a normal anatomical variant. Meningioma is the most frequent intracranial benign tumor,accounting for 37.1% of tumors overall[1].However,the concomitant occurrence of meningioma and other intracranial benign tumors is extremely rare[2].Only a few coexisting meningioma and other intracranial benign tumor cases have been reported in previous publications,such as pituitary adenoma[3,4],craniopharyngioma[5]and . A large tumor was seen very stuck to the normal brain tissue. Lateral sphenoid wing meningioma Lateral sphenoid wing meningioma or pterional meningioma is a type of intracranial meningioma that arise from the pterion and typically grow along the Sylvian fissure. The 2023 edition of ICD-10-CM D32.9 became effective on October 1, 2022. 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