Diagnostic Considerations

Depending on the radiological features and clinical manifestations, the following differential diagnoses of sphenoid wing meningioma should be considered^{[73, 74, 75, 76, 77]}:

Fibrous dysplasia
Paget disease
Brown tumor
Osteogenic sarcoma
Eosinophilic granuloma
Aneurysmal bone cyst
Osteoma
Hemangioma
Hemangiopericytoma
Epidermoid tumor and dermoid
Multiple myeloma
Plasmacytoma
Giant cell tumor
Metastatic cancer

Workup

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Media Gallery

Coronal T1-weighted MRI with gadolinium enhancement of a sphenoid wing meningioma with some degree of encasement of bilateral cavernous sinuses.
T1-weighted MRI with gadolinium (coronal section) of same patient with sphenoid wing meningioma. A better visualization of en plaque growth of the meningioma along the convexity of the cerebral hemisphere on the left side is seen, in addition to better illustration of intracavernous carotid arteries bilaterally and en plaque growth of meningioma inferiorly and laterally around both temporal lobes.
T1-weighted gadolinium enhanced (sagittal section) of same patient with meningioma of the sphenoid wing.
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.
MRI brain T2W (left) and T1W Fat-Sat (right) sequences showing involvement of the left sphenoid wing associated with dural thickening and the periorbita. Notice proptosis of the left globe secondary to left orbital wall thickening.
This is a typical appearance of a sphenoorbital meningioma on the MRI. The image depicts a contrasted MRI of the brain which shows an enhancing mass along the sphenoid ridge, orbital apex, and even the temporalis muscle. The orbital involvement of the tumor causes significant proptosis of the affected eye.
After elevation of the myocutaneous flap; note the underlying bone is infiltrated with tumor.
A frontotemporal craniotomy is performed to elevate the affected bone. Underlying it, dura is seen. The dura is also infiltrated with the tumor.
The tumor debulking is performed using the micro-instruments and high-speed diamond drill bit.
The dura is opened. Any intradural portion of the tumor is resected, if any. The involved dura is cut and discarded.
Important neurovascular structures are decompressed including the orbit, orbital apex, superior orbital fissure. The tumor has also infiltrated the periorbita. Some periorbital fat can be seen.
After gross total resection of the tumor (star = orbit, circle = frontal lobe, triangle = temporal lobe).
After closing the dura with a synthetic dural substitute, cranium is replaced and secured with titanium hardware. Medpore cranioplasty (white plates) are placed for further reconstruction and to restore cosmesis.

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Author

William T Couldwell, MD, PhD Professor of Neurosurgery (Adult Neurosurgery) and Joseph J Yager Chair, Department of Neurosurgery, Adjunct Professor of Surgery (Otolaryngology-Head and Neck Surgery), University of Utah School of Medicine; Attending Neurosurgeon, University of Utah Hospital

William T Couldwell, MD, PhD is a member of the following medical societies: American Academy of Neurological Surgery, American Association for the Advancement of Science, American Association of Neurological Surgeons, American College of Surgeons, American Neurological Association, California Association of Neurological Surgeons, California Medical Association, Congress of Neurological Surgeons, International Meningioma Society, Los Angeles Academy of Medicine, Los Angeles County Medical Association, Neurosurgical Society of America, New York Academy of Sciences, New York State Neurosurgical Society, North American Skull Base Society, North Dakota Medical Association, Pituitary Society, Society for Neuro-Oncology, Society of Neurological Surgeons, Utah State Neurosurgical Society, World Academy of Neurological Surgery

Disclosure: Editor in Chief for: JNS Publishing - Neurosurgical Focus.

Coauthor(s)

Bhupendra C K Patel, MD, FRCS Professor of Ophthalmic Plastic and Facial Cosmetic Surgery, Department of Ophthalmology and Visual Sciences, John A Moran Eye Center, University of Utah School of Medicine

Bhupendra C K Patel, MD, FRCS is a member of the following medical societies: American Academy of Ophthalmology, American Society of Ophthalmic Plastic and Reconstructive Surgery, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Robert B Kim, MD, MS Chief Resident, Department of Neurosurgery, Clinical Neurosciences Center, University of Utah School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Hampton Roy, Sr, MD † Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

Sally B Zachariah, MD Associate Professor, Department of Neurology, University of South Florida College of Medicine; Director, Department of Neurology, Division of Strokes, Veteran Affairs Medical Center of Bay Pines

Sally B Zachariah, MD is a member of the following medical societies: American Academy of Neurology, American Heart Association, American Society of Neuroimaging

Disclosure: Partner received none from none for none.

Gmaan Ali M Alzhrani , MBBS, MA Fellow in Skull Base and Vascular Surgery, Clinical Neuroscience Center, University of Utah School of Medicine

Gmaan Ali M Alzhrani , MBBS, MA is a member of the following medical societies: American Academy of Neurological Surgery, Congress of Neurological Surgeons, Saudi Association of Neurological Surgery

Disclosure: Nothing to disclose.

Acknowledgements

Suzan Khoromi, MD Fellow, Pain and Neurosensory Mechanisms Branch, National Institute of Dental and Cranial Research, National Institutes of Health

Suzan Khoromi, MD is a member of the following medical societies: American Academy of Neurology, American Pain Society, and International Association for the Study of Pain

Disclosure: Nothing to disclose.

Brian R Younge, MD Professor of Ophthalmology, Mayo Clinic School of Medicine

Brian R Younge, MD is a member of the following medical societies: American Medical Association, American Ophthalmological Society, and North American Neuro-Ophthalmology Society

Disclosure: Nothing to disclose.