1. Sphenoid Wing Meningiomas
Case report

2. 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

3. 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

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

5. CT scanning without contrast

6. CT scanning with contrast

7. 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

8. 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

9. Postoperative
2 days after surgery

10. Postoperative 3 months after surgery

11. 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

12. 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%)

13. 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

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

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

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

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

18. 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

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

20. 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

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

22. Thank you