Sphenoid Wing Meningiomas Case report

Abstrat Meningiomas represent about 20% of all Primary intracranial tumors, making them the second most common type of primary brain tumor. About 20% of them are in the sphenoid wing. The diagnostic evaluation and surgical management of this case are reported

Case report A 38 years old female patient presented with complains that her right eye was "bulging" and appeared swollen. She had experienced occasional headache and periorbital pain but denied any vision changes She had experienced occasional dizziness and blurring vision Her complaints began more than 5 months. Past medical and surgical history free except for insulin depended D.M (more than 10 years) Family history free for tumors

Clinical examination In general healthy patient Has mild exophthalmus right eye Conjunctivitis Other ophthalmic examination unremarkable Lower cranial nerves unremarkable

CT scanning without contrast

CT scanning with contrast

Treatment She was planned for surgery on 2/2/2016 Goal of surgery was radical excision of the tumor Preparation : - G.A. - Supine position with head tilted to lift - Antiepileptic drug (Epanutin) - Broad-spectrum antibiotic - Dexamethasone - C.S.F. drainage - Right frontotemporal (pterional) approach was used

Treatment con. Total excision was achieved Operation procedure took more than 4 hours Postoperative patient referred to I.C.U. After 4 hours extubated Few hours later began orally fluid On second day referred to board One week postoperative was discharged home with orally 300mg Epanutin and 2Dexamethasone daily

Postoperative 2 days after surgery

Postoperative 3 months after surgery

Postoperative con. Patient showed mild improvement after 1 week regarding her right eye exophthalmus and conjunctivitis but still has headache and takes analgesics The histopathological finding revieled meningioma grade I without sign of malignancy In later follow-up headache and dizziness were bitter bitter

Meningiomas are benign brain tumors They originate from the arachnoid (not the dura)  Meningiomas are much more common in females and are more common after 50 years of age About 20% of them are in the sphenoid wing They are the most common tumors of the sphenoid wing in the anterior skull base Sex :75%women &25% men Age (onset is 50 years increases thereafter) Mortality (5years:87%&10years:58%)

Risk factors A common etiology for meningiomas is radiation exposure Head trauma used to be considered a possible risk factor Hereditary predisposition Hormonal factors (eg, estrogen, progesterone): 30% of meningiomas have estrogen receptors , Progesterone receptors have been shown in 81% of women and in 40% of men with meningiomas?? Viruses

classification En-plaque/spheno-orbital/hyperostotic Globoid meningeomas: 1) deep, inner, or clinoidal 2) middle or alar 3) lateral, outer, or pterional

En-plaque/spheno-orbital/hyperostotic - carpet-like dural growth -reactive hyperostosis - extends : * posteriorly :cavernous sinus * anteriorly : orbital apex

Globoid meningiomas 1) deep, inner, or clinoidal 2) middle or alar 3) lateral, outer, or pterional

Histologic finding According to WHO : Benign(grade I):do not invade the brain parenchyma Atypical(grade II) Malignant, anaplastic (grade III)

Clinical features Clinical features unique to this group of meningiomas include: - exophthalmus - diplopia due to occlumotor nerve dysfunction - progressive visual loss - ectropion - conjunctivitis - olfactory hallucinations - headache , periorbital pain - numbness in the territory of the V1 branch - seizures

Workup - endocrine(TSH,FSH&LH) - plain skull film - CT scan and MRI - carotid angiography - preoperative visual testing

Treatment Medical treatment Indications: - in atypical and malignant meningiomas as adjunct to surgery - in partially resected benign meningiomas - in recurrent of meningiomas after surgical resection Drugs: - antiestrogen - antiprogesteron - antineoplastic

Surgery indications: - size of lesion>2,5cm - presence of signs or symptoms - changes in the adjacent cerebral tissue (edema) on imaging studies

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