To demonstrate by examples the common mimics of meningioma with the differentiating features. The tumor capsule is bipolar coagulated medial to the ipsilateral on and the tumor is debulked. Additionally, there was a broadbased extraaxial lesion at the planum sphenoidale eccentric to the right, which enhanced homogenously and measured 1. We read with keen interest the article by bander et al. Feb 01, 2016 read planum sphenoidale and tuberculum sellae meningiomas. Meningiomas are the most common extraaxial tumors of the central nervous system. Some meningiomas can cause problems despite their benign nature, because they are difficult to remove when they are located in. Planum sphenoidale meningioma is the meningioma attached to the dura of the planum sphenoidale, lying on the midline posterior to the olfactory nerve meningiomas and anterior to. The who classification scheme recognizes 15 variations of meningiomas according to their cell type as seen under a microscope. Planum sphenoidale meningiomas are located more anterior and in proximity of the olfactory groove location 4, 10. We report a modern surgical technique specific for planum sphenoidale and tuberculum sellae meningiomas with associated outcome.
These tumors originate in the meninges, which are the outer three layers of tissue between the skull and the brain that cover and protect the brain just under the skull. Meningiomas constitute around 20% of the intracranial tumors found in adults. Unenhanced axial ct of the base of the skull shows a hyperdense midline mass white arrows arising from the planum sphenoidale region. Common locations include the convexity of the calvarium, frontal fossa olfactory groove, tuberculum sella, sphenoid wing and the area around the jugular foramen in the posterior fossa. Planum sphenoidale meningiomas account for 510% of all intracranial meningiomas. Tuberculum sellae and planum sfenoidale meningiomas represent. Meningiomas grow out of the middle layer of the meninges. Role of planum sphenoidale meningioma resection in improving. A delay in the diagnosis of meningiomas of the tuberculum sellae and planum sphenoidale can lead to poor surgical results in terms of visual prognosis, morbidity, and mortality.
The latest cancer research uk statistics show that between a quarter and a third 2533% of all primary brain tumours in adults is a meningioma. Surgery of small anterior skull base meningiomas by. Optic tract edema in a meningioma of the tuberculum sellae. The tumors are usually bilateral based on their midline origin, although they can also be unilateral. Ps and ts meningiomas can extend into adjacent areas such as. New concepts in the management of optic nerve sheath meningiomas.
Endoscopic endonasal resection of skull base meningiomas. Primary dural lymphoma masquerading as a meningioma. The extended pterional approach allows excellent results for. It marks the posterior limit of the anterior skull base, and meningiomas that arise from this site are known as. Twentyseven patients were found to have tumors arising mainly from the planum sphenoidale or the tuberculum sellae. Surgical management of tuberculum sellae and planum.
Meningiomas classifications, risk factors, diagnosis and. The tumor was well circumscribed and no osseous abnormalities were detected. Meningioma brain tumors brigham and womens hospital. Sphenoid wing meningioma with extraocular muscle involvement mimicking idiopathic orbital inflammation. Any information contained in this pdf file is automatically generated from digital material.
Magnetic resonance imaging findings were consistent with en plaque meningioma of the planum sphenoidale, which encircled the right optic nerve at the optic canal. Mar 01, 2011 intraoperative photograph of a tuberculum sellae meningioma via the anterior interhemispheric approach. In order to decrease intraoperative bleeding, early interception of these feeding arteries is essen tial. Total removal of meningiomas of the anterior cranial fossa was obtained in 86. It originates from the arachnoid not the dura, the tissue covering the brain and spinal cord lying deep to the dura. However, after 2 followup mri scans showed slight growth and because of persisting headaches, the patient decided the meningioma should be removed. Demonstrates the technique of and exposure afforded by a frontotemporal pteryonal craniotomy for resection of planum sphenoidale meningioma. They are a nonglial neoplasm that originates from the arachnoid cap cells of the meninges and are typically benign with a low recurrence rate, but rarely can be malignant meningiomas occur in a magnitude of locations, one of the less common places being the. Meningiomas of the tuberculum sellae and planum sphenoidale.
In the scan they came to know as planum sphenoidale meningioma. The right eye had visual acuity of 2025, an afferent pupillary defect, pale optic nerve, and cecocentral scotoma. A cerebral mri scan showed a small planum sphenoidale meningioma 15. Planum sphenoidale meningioma stock image c0432777. Anterior interhemispheric approach for tuberculum sellae.
Primary dural lymphomas are a distinct entity that may mimic meningioma and cause vision loss. Endoscopic transnasal suprasellar approach for anterior. Olfactory grooveplanum sphenoidale meningiomas request pdf. This axial cross sectional t1 weighted mr image with contrast shows a large, enhancing meningioma with mass effect arising from the planum sphenoidale. They are often bilateral rather than unilateral but asymmetrical 1. It grows slowly and usually remains clinically undetectable during the early stageand is often of considerable size, 3. A meningioma is a type of tumor that develops from the meninges, the membrane that covers the brain and spinal cord.
They may also cause headache, double vision and loss of pituitary function. Although olfactory meningiomas are rare, they are treatable and reversal of dementialike symptoms can be expected. Arise from the flat part of the sphenoid bone anterior to the chiasmatic sulcus. The extended pterional approach allows excellent results for removal of anterior. Anterior cranial base meningiomas are rare tumors in children. Site related relapses with planum sphenoidale or olfactory groove meningioma, tumor recurrence reported in 7. Planum sphenoidale and tuberculum sellae meningiomas. The lesion was inden ting on the left optic nerve and the optic chiasm fig. Operative nuances of a modern surgical technique with outcome and proposal of a new classification system, world neurosurgery on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. Acms, originating from the arachnoid layer covering the anterior clinoid process acp, has an incidence of 34% to 43. Endoscopic endonasal versus transcranial approach to. Oct 14, 2015 site related relapses with planum sphenoidale or olfactory groove meningioma, tumor recurrence reported in 7. A delay in the diagnosis or treatment may be detrimental to visual recovery. Histopathologic and molecular analysis revealed a lowgrade bcell lymphoma.
Thus, it would appear that some cases of apparently bilateral onsms are truly bilateral, whereas others represent either the spread of a planum sphenoidale meningioma to both optic canals or of a unilateral onsm across the planum to the contralateral optic. A sphenoid ridge meningioma is found along the ridge of bone behind the eyes and nose. It forms part of the anterior skull base, separating the anterior cranial fossa from the sphenoid sinuses. A delay in the diagnosis of meningiomas of the tuberculum sellae and planum sphenoidale can lead to poor surgical results in terms of visual prognosis.
The treatment of choice is surgical removal with the goal of improving vision and achieving complete tumor removal. Operative nuances of a modern surgical technique with outcome and proposal of a. Together with the anterior clinoid processes, it forms the roof of the sphenoid sinus. Meningiomas of the midline anterior skull base such as the olfactory groove meningioma presented in this case report are a rare clinical entity and represent about 10% of all intracranial meningiomas. The world health organization who classification of brain tumors is the most widely utilized tool in grading tumor types. This case illustrates the typical radiological findings of a planum sphenoidale meningioma. Planum sphenoidale meningioma planum sphenoidale meningiomas are anterior cranial fossa meningiomas, overlying the area of the cribriform plate of the ethmoid bone, sphenofrontal suture, and planum sphenoidale. These variations are called meningioma subtypes the technical term for these cell variations is histological subtypes. The lesion also pushed against the left cavernous sinus, without evidence of invasion. It is known in the terminologia anatomica 2019 as the jugum sphenoideum or sphenoidal yoke 1 gross anatomy. Symptoms depend on the location and occur as a result of the tumor pressing on nearby tissue. The limbus sphenoidaledentified as a small borderline separating the planum sphenoidale and chiasmatic sulcus. Meningioma tumor surgery, symptoms and treatment upmc. The tumors are usually bilateral based on their midline origin, although they can also be.
Hello johny249, the following information would be of great help. The planum sphenoidale or jugum sphenoidale is the planar surface of the sphenoid bone connecting the two lesser wings, and lies anterior to the sella turcica. The tumor was totally resected using a left pterional approach. Olfactory grooveplanum sphenoidale meningiomas springerlink. Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. Features are almost certainly those of a planum sphenoidale meningioma, with no other diagnosis being a serious differential. Olfactory groove and planum sphenoidale meningiomas occur along the anterior cranial base overlying the area of the cribriform plate of the ethmoid bone. Chinezu1, dorin nicolae gherasim2 neurosurgery departement, targu mures clinical emergency hospital 16th year neurosurgery resident 22nd year neurosurgery resident abstract introduction.
These treatment options could include surgery andor stereotactic radiosurgery, depending upon the location of the tumor and symptoms. The pterional approach in a case of planum sphenoidale meningioma 119 clinical case the pterional approach in a case of planum sphenoidale meningioma tabita larisa cazac1, d. A computer tomography ct scan ordered by the neurologist upon initial assessment revealed a 6 cm planum sphenoidale mass located in the frontal lobe, suggesting a benign meningioma figures 1 and 2. My friend doesnt have any symptoms apart from headache and his meningioma size is 2. Role of planum sphenoidale meningioma resection in. The planum sphenoidale or jugum sphenoidale is the planar surface of the sphenoid bone. The tumor was internally debulked to preserve the optic nerve. Planum sphenoidale meningioma leading to visual disturbance. Jan 25, 2018 demonstrates the technique of and exposure afforded by a frontotemporal pteryonal craniotomy for resection of planum sphenoidale meningioma. Most meningiomas 8590 percent are categorized as benign tumors, while 1015 percent being atypical or malignant cancerous. Planum sphenoidale the planum sphenoidale or jugum sphenoidale is the planar surface of the sphenoid bone connecting the two lesser wings, and lies anterior to the sella turcica. Frontotemporal craniotomy for planum sphenoidale meningioma. Planum sphenoidale meningioma is the meningioma attached to the dura of the planum sphenoidale, lying on the midline posterior to the olfactory nerve meningiomas and anterior to the tuberculum sella meningiomas.
The extended pterional approach allows excellent results. Occasionally seizures, dementia, trouble talking, vision problems, one. This mass was encroaching on the right optic nerve and was thought to represent a meningioma. Further evaluation showed no evidence of systemic disease.
A new classification system that can guide the surgical approach and may predict surgical risk is proposed. Keyhole craniotomies are increasingly being used for lesions of the skull base. An aggressive sphenoid wing meningioma causing foster kennedy syndrome. Olfactory groove meningioma ogm originates from the anterior cranial base, commonly at the cribriform plate of the ethmoid bone, planum sphenoidale or the.
Meningiomas are much more common in females, and are more common after 50 years of age. The eyebrow supraorbital keyhole approach is gradually preferred to treat tuberculum sellae and planum sphenoidale meningiomas as a less invasive approach compared to the more traditional approaches. It marks the posterior limit of the anterior skull base, and meningiomas that arise from this site are known as planum. Management of intracranial meningiomas using keyhole techniques. Dumitrescu2 1the university of medicine and pharmacy carol davila, bucharest, romania. Meningiomas that arise in the midline from the area above and in front of the pituitary gland and sella the tuberculum sella and planum sphenoidale, typically cause progressive visual loss from optic nerve and chiasm compression. Planum sphenoidale definition of planum sphenoidale by. Delayed treatment of orbital meningioma in a pregnant chinese. Request pdf role of planum sphenoidale meningioma resection in improving visual function introduction. Endoscopic endonasal versus transcranial approach to tuberculum. A sphenoid wing meningioma is a benign brain tumor near the sphenoid bone. In many cases, it may be difficult to determine whether a meningioma began in the posterior orbit or optic canal and then spread intracranially, or whether the tumor began. They often are mentioned in the same context as meningiomas originating from tuberculum sellae, diaphragma sellae, planum sphenoidale, or optic canal meningiomas.
Features are categorically not those of an aneurysm, thrombosed or otherwise. A large planum sphenoidale meningioma with sinonasal extension. A 36yearold female presented to the oculoplastics service stating that her left eye was bulging and appeared swollen. The eyebrow supraorbital keyhole approach is gradually preferred to treat tuberculum sellae and planum sphenoidale meningiomas as a less invasive. Olfactory groove and planum sphenoidale meningiomas occur along the anterior cranial base overlying the area of the cribriform plate of the ethmoid bone, frontosphenoid suture, and planum. Anterior clinoidal meningiomas acms represent special entity of meningiomas that have been referred to as, or grouped with, suprasellar, parasellar, sphenoid wing, or frontal skull base meningiomas. Contrary to a prior report on this topic, edema along the optic tract is not only seen in craniopharyngiomas but may be seen although rarely in other common parasellar tumors, as in our case of a tuberculum sellae meningioma. If the inline pdf is not rendering correctly, you can download the pdf file here.
Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from january 2012 to june 20. They are typically slowgrowing tumors, explaining why some patients remain asymptomatic and, therefore, undiagnosed for extended periods of time. The patient was referred to a neurologist, and an mri s can was performed. He suggested radio surgery is preferrable, it wont have any complications. Meningioma, also known as meningeal tumor, is typically a slowgrowing tumor that forms from the meninges, the membranous layers surrounding the brain and spinal cord. Endoscopic endonasal resection of a synchronous pituitary. The planum sphenoidale is a common term for the anterior horizontal part of the superior surface of the body of the sphenoid bone. Planum sphenoidale ps and tuberculum sellae ts meningiomas cause visual symptoms due to compression of the optic chiasm. Surgical management of tuberculum sellae and planum sphenoidale meningiomas adrian bala. Request pdf planum sphenoidale and tuberculum sellae meningiomas. We report a case of tuberculum sellae meningioma with optic tract edema.
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