Surgical Care

Total microsurgical resection of sphenoid wing meningioma is usually curative. A recurrence risk approaching 30% has been reported when incomplete removal is attempted.^{[58, 84]}Depending on the bony involvement and the soft tissue component of the tumor, the principles of resecting a sphenoid wing en plaque meningioma are complete removal of all the involved bone, including the sphenoid wing, orbital roof, and orbital lateral wall. Decompression of optic nerve, superior orbital fissure, and maxillary branch of the trigeminal nerve posteriorly to foramen rotundum should be accomplished.

The skin incision is made 0.5-1 cm anterior to the tragus at the level of the zygomatic arch and extended behind the hairline toward the widow peak. It can be curved back across the midline toward the contralateral superior temporal line, if needed. Care must be taken not to injure the temporal branch to the frontalis muscle or the facial nerve that passes anterior to it. The temporalis muscle, along with the superficial and the deep fascial layers, are incised in similar fashion from the skin down to the bone. The musculocutaneous flap is reflected anteriorly using a periosteal elevator. Avoid cauterizing the blood supply and innervation to the temporalis muscle to prevent future muscle atrophy.

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.

Multiple bur holes are then made around the invaded or hyperostotic bone to prevent excessive bleeding and dural tear. The drill is then used to connect the bur holes and to remove the invaded bone. This process continues until all hyperostotic tissue is removed from the sphenoid wing down to the meningo-orbital band.

The meningo-orbital band is then coagulated and cut sharply, followed by dural stripping from the superior orbital fissure and the anterior part of the lateral wall of the cavernous sinus, exposing the middle fossa floor laterally to the foramen spinosum and posteriorly to the foramen rotundum. Hyperostotic tissue is then removed in a similar manner from the orbital roof and lateral walls of the orbit.

The superior orbital fissure is completely decompressed. The optic nerve in the canal is unroofed, and anterior clinoidectomy is performed.

Once the bone removal is complete, attention is focused on resecting the intradural portion of the tumor, and the dura is resected beyond the enhanced dural tail. The intraorbital extension with involvement of the periorbita and extraocular muscles should also be removed.

Abdominal fat or temporalis fascia with or without pericranial flap can be used to repair the frontal, maxillary, and ethmoid sinuses if they have been opened to prevent postoperative development of a CSF leak and rhinorrhea. A duraplasty is performed using a dural substitute.

There is no clear consensus in the literature regarding whether to reconstruct the orbit. Orbital wall reconstruction has been recommended whenever the orbital floor or more than one wall has been resected or the periorbita was resected to prevent occurrence of pulsatile enophthalmos postoperatively.^[85]However, studies have concluded that this complication is uncommon and that orbital reconstruction is unnecessary except in rare occasions when the orbital rim is resected.^{[9, 86, 87]}

When orbital reconstruction is needed, the area can be reconstructed using mesh, dural substitute, or split bone if only the superior and lateral walls of the orbit have been removed. The cranial flap is placed back if it was not involved by the tumor, or a piece of Medpor can be used to cover the cranial defect, making sure to cover the keyhole area. The temporal muscle is then reattached, and the skin is closed in two layers.

Medical Care

Anecdotal reports have described using antihormonal agents in the treatment of meningiomas. Medical treatment is reserved for atypical and malignant meningiomas as an adjunct to surgery.

Medication

Cushing H, Eisenhardt L, Thomas C, eds. Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results. Springfield, Ill: Charles C Thomas; 1938.
Rockhill J, Mrugala M, Chamberlain MC. Intracranial meningiomas: an overview of diagnosis and treatment. Neurosurg Focus. 2007. 23 (4):E1. [QxMD MEDLINE Link].
Bright R. Reports of Medical Cases, Selected With a View of Illustrating the Symptoms and Cure of Diseases by a Reference to Morbid Anatomy. London: Longman, Rees, Orme, Brown & Green; 1827.
Yamashita J, Handa H, Iwaki K, Abe M. Recurrence of intracranial meningiomas, with special reference to radiotherapy. Surg Neurol. 1980 Jul. 14 (1):33-40. [QxMD MEDLINE Link].
Claus EB, Bondy ML, Schildkraut JM, Wiemels JL, Wrensch M, Black PM. Epidemiology of intracranial meningioma. Neurosurgery. 2005 Dec. 57 (6):1088-95; discussion 1088-95. [QxMD MEDLINE Link].
Ostrom QT, Gittleman H, de Blank PM, Finlay JL, Gurney JG, McKean-Cowdin R, et al. American Brain Tumor Association Adolescent and Young Adult Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2016 Jan. 18 Suppl 1:i1-i50. [QxMD MEDLINE Link].
Ibebuike K, Ouma J. Demographic profile of patients diagnosed with intracranial meningiomas in two academic hospitals in Johannesburg, South Africa: a 12-month prospective study. Afr Health Sci. 2014 Dec. 14 (4):939-45. [QxMD MEDLINE Link].
Bonavolontà G, Strianese D, Grassi P, Comune C, Tranfa F, Uccello G, et al. An analysis of 2,480 space-occupying lesions of the orbit from 1976 to 2011. Ophthal Plast Reconstr Surg. 2013 Mar-Apr. 29 (2):79-86. [QxMD MEDLINE Link].
Bowers CA, Sorour M, Patel BC, Couldwell WT. Outcomes after surgical treatment of meningioma-associated proptosis. J Neurosurg. 2016 Sep. 125 (3):544-50. [QxMD MEDLINE Link].
Sughrue ME, Rutkowski MJ, Chen CJ, Shangari G, Kane AJ, Parsa AT, et al. Modern surgical outcomes following surgery for sphenoid wing meningiomas. J Neurosurg. 2013 Jul. 119 (1):86-93. [QxMD MEDLINE Link].
Nakamura M, Roser F, Jacobs C, Vorkapic P, Samii M. Medial sphenoid wing meningiomas: clinical outcome and recurrence rate. Neurosurgery. 2006 Apr. 58 (4):626-39, discussion 626-39. [QxMD MEDLINE Link].
Scarone P, Leclerq D, Héran F, Robert G. Long-term results with exophthalmos in a surgical series of 30 sphenoorbital meningiomas. Clinical article. J Neurosurg. 2009 Nov. 111 (5):1069-77. [QxMD MEDLINE Link].
Rhoton AL Jr. The anterior and middle cranial base. Neurosurgery. 2002 Oct. 51 (4 Suppl):S273-302. [QxMD MEDLINE Link].
MacCarty CS. Meningiomas of the sphenoidal ridge. J Neurosurg. 1972 Jan. 36 (1):114-20. [QxMD MEDLINE Link].
al-Mefty O, Ayoubi S. Clinoidal meningiomas. Acta Neurochir Suppl (Wien). 1991. 53:92-7. [QxMD MEDLINE Link].
Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach. Neurosurg Focus. 2011 May. 30 (5):E3. [QxMD MEDLINE Link].
Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus. 2003 Jun 15. 14 (6):e4. [QxMD MEDLINE Link].
Bondy M, Ligon BL. Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol. 1996 Sep. 29 (3):197-205. [QxMD MEDLINE Link].
Busch D. Genetic susceptibility to radiation and chemotherapy injury: diagnosis and management. Int J Radiat Oncol Biol Phys. 1994 Nov 15. 30 (4):997-1002. [QxMD MEDLINE Link].
Morgenstern PF, Shah K, Dunkel IJ, Reiner AS, Khakoo Y, Rosenblum MK, et al. Meningioma after radiotherapy for malignancy. J Clin Neurosci. 2016 Aug. 30:93-7. [QxMD MEDLINE Link].
Friedman DL, Whitton J, Leisenring W, Mertens AC, Hammond S, Stovall M, et al. Subsequent neoplasms in 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2010 Jul 21. 102 (14):1083-95. [QxMD MEDLINE Link].
Taylor AJ, Little MP, Winter DL, Sugden E, Ellison DW, Stiller CA, et al. Population-based risks of CNS tumors in survivors of childhood cancer: the British Childhood Cancer Survivor Study. J Clin Oncol. 2010 Dec 20. 28 (36):5287-93. [QxMD MEDLINE Link].
Sadetzki S, Flint-Richter P, Ben-Tal T, Nass D. Radiation-induced meningioma: a descriptive study of 253 cases. J Neurosurg. 2002 Nov. 97 (5):1078-82. [QxMD MEDLINE Link].
Longstreth WT Jr, Phillips LE, Drangsholt M, Koepsell TD, Custer BS, Gehrels JA, et al. Dental X-rays and the risk of intracranial meningioma: a population-based case-control study. Cancer. 2004 Mar 1. 100 (5):1026-34. [QxMD MEDLINE Link].
CAHAN WG, WOODARD HQ. Sarcoma arising in irradiated bone; report of 11 cases. Cancer. 1948 May. 1 (1):3-29. [QxMD MEDLINE Link].
Al-Mefty O, Topsakal C, Pravdenkova S, Sawyer JR, Harrison MJ. Radiation-induced meningiomas: clinical, pathological, cytokinetic, and cytogenetic characteristics. J Neurosurg. 2004 Jun. 100 (6):1002-13. [QxMD MEDLINE Link].
Shenoy SN, Munish KG, Raja A. High dose radiation induced meningioma. Br J Neurosurg. 2004 Dec. 18 (6):617-21. [QxMD MEDLINE Link].
Godlewski B, Drummond KJ, Kaye AH. Radiation-induced meningiomas after high-dose cranial irradiation. J Clin Neurosci. 2012 Dec. 19 (12):1627-35. [QxMD MEDLINE Link].
Choudhary A, Pradhan S, Huda MF, Mohanty S, Kumar M. Radiation induced meningioma with a short latent period following high dose cranial irradiation - case report and literature review. J Neurooncol. 2006 Mar. 77 (1):73-7. [QxMD MEDLINE Link].
Boljesíková E, Chorváth M, Hurta P, Steno J, Bízik I. Radiation-induced meningioma with a long latency period: a case report. Pediatr Radiol. 2001 Sep. 31 (9):607-9. [QxMD MEDLINE Link].
Pećina-Šlaus N, Kafka A, Lechpammer M. Molecular Genetics of Intracranial Meningiomas with Emphasis on Canonical Wnt Signalling. Cancers (Basel). 2016 Jul 15. 8 (7):[QxMD MEDLINE Link].
Mawrin C, Chung C, Preusser M. Biology and clinical management challenges in meningioma. Am Soc Clin Oncol Educ Book. 2015. e106-15. [QxMD MEDLINE Link].
Hilton DA, Shivane A, Kirk L, Bassiri K, Enki DG, Hanemann CO. Activation of multiple growth factor signalling pathways is frequent in meningiomas. Neuropathology. 2016 Jun. 36 (3):250-61. [QxMD MEDLINE Link].
Benson VS, Kirichek O, Beral V, Green J. Menopausal hormone therapy and central nervous system tumor risk: large UK prospective study and meta-analysis. Int J Cancer. 2015 May 15. 136 (10):2369-77. [QxMD MEDLINE Link].
Carroll RS, Zhang J, Black PM. Expression of estrogen receptors alpha and beta in human meningiomas. J Neurooncol. 1999 Apr. 42 (2):109-16. [QxMD MEDLINE Link].
Carroll RS, Glowacka D, Dashner K, Black PM. Progesterone receptor expression in meningiomas. Cancer Res. 1993 Mar 15. 53 (6):1312-6. [QxMD MEDLINE Link].
Hsu DW, Efird JT, Hedley-Whyte ET. Progesterone and estrogen receptors in meningiomas: prognostic considerations. J Neurosurg. 1997 Jan. 86 (1):113-20. [QxMD MEDLINE Link].
Olson JJ, Beck DW, Schlechte JA, Loh PM. Effect of the antiprogesterone RU-38486 on meningioma implanted into nude mice. J Neurosurg. 1987 Apr. 66 (4):584-7. [QxMD MEDLINE Link].
Chen J, Chen G. Expression of androgen receptor in meningiomas. J Tongji Med Univ. 2001. 21 (2):140-2. [QxMD MEDLINE Link].
Preston-Martin S. Descriptive epidemiology of primary tumors of the brain, cranial nerves and cranial meninges in Los Angeles County. Neuroepidemiology. 1989. 8 (6):283-95. [QxMD MEDLINE Link].
Kuan AS, Chen YT, Teng CJ, Wang SJ, Chen MT. Risk of meningioma in patients with head injury: a nationwide population-based study. J Chin Med Assoc. 2014 Sep. 77 (9):457-62. [QxMD MEDLINE Link].
Ostrom QT, Gittleman H, Fulop J, Liu M, Blanda R, Kromer C, et al. CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. Neuro Oncol. 2015 Oct. 17 Suppl 4:iv1-iv62. [QxMD MEDLINE Link].
Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neurooncol. 2010 Sep. 99 (3):307-14. [QxMD MEDLINE Link].
Mehta N, Bhagwati S, Parulekar G. Meningiomas in children: A study of 18 cases. J Pediatr Neurosci. 2009 Jul. 4 (2):61-5. [QxMD MEDLINE Link].
Yue NC, Longstreth WT Jr, Elster AD, Jungreis CA, O'Leary DH, Poirier VC. Clinically serious abnormalities found incidentally at MR imaging of the brain: data from the Cardiovascular Health Study. Radiology. 1997 Jan. 202 (1):41-6. [QxMD MEDLINE Link].
Vernooij MW, Ikram MA, Tanghe HL, Vincent AJ, Hofman A, Krestin GP, et al. Incidental findings on brain MRI in the general population. N Engl J Med. 2007 Nov 1. 357 (18):1821-8. [QxMD MEDLINE Link].
Linsler S, Keller C, Urbschat S, Ketter R, Oertel J. Prognosis of meningiomas in the early 1970s and today. Clin Neurol Neurosurg. 2016 Oct. 149:98-103. [QxMD MEDLINE Link].
da Silva CE, de Freitas PE. Large and giant skull base meningiomas: The role of radical surgical removal. Surg Neurol Int. 2015 Jun 29. 6:113. [QxMD MEDLINE Link].
da Silva CE, Peixoto de Freitas PE. Recurrence of Skull Base Meningiomas: The Role of Aggressive Removal in Surgical Treatment. J Neurol Surg B Skull Base. 2016 Jun. 77 (3):219-25. [QxMD MEDLINE Link].
Ohaegbulam SC. Geographical neurosurgery. Neurol Res. 1999 Mar. 21 (2):161-70. [QxMD MEDLINE Link].
Adegbite AB, Khan MI, Paine KW, Tan LK. The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg. 1983 Jan. 58 (1):51-6. [QxMD MEDLINE Link].
SIMPSON D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957 Feb. 20 (1):22-39. [QxMD MEDLINE Link].
Sughrue ME, Kane AJ, Shangari G, Rutkowski MJ, McDermott MW, Berger MS, et al. The relevance of Simpson Grade I and II resection in modern neurosurgical treatment of World Health Organization Grade I meningiomas. J Neurosurg. 2010 Nov. 113 (5):1029-35. [QxMD MEDLINE Link].
Nanda A, Bir SC, Maiti TK, Konar SK, Missios S, Guthikonda B. Relevance of Simpson grading system and recurrence-free survival after surgery for World Health Organization Grade I meningioma. J Neurosurg. 2016 Apr 8. 1-11. [QxMD MEDLINE Link].
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol. 2007 Aug. 114 (2):97-109. [QxMD MEDLINE Link].
Shrivastava RK, Sen C, Costantino PD, Della Rocca R. Sphenoorbital meningiomas: surgical limitations and lessons learned in their long-term management. J Neurosurg. 2005 Sep. 103 (3):491-7. [QxMD MEDLINE Link].
Bikmaz K, Mrak R, Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg. 2007 Nov. 107 (5):905-12. [QxMD MEDLINE Link].
Talacchi A, De Carlo A, D'Agostino A, Nocini P. Surgical management of ocular symptoms in spheno-orbital meningiomas. Is orbital reconstruction really necessary?. Neurosurg Rev. 2014 Apr. 37 (2):301-9; discussion 309-10. [QxMD MEDLINE Link].
Oluigbo CO, Choudhari KA, Flynn P, McConnell RS. Meningioma presenting with transient ischaemic attacks. Br J Neurosurg. 2004 Dec. 18 (6):635-7. [QxMD MEDLINE Link].
Rodríguez-Colón G, Bratton EM, Serracino H, Bennett JL, Hink EM. Sphenoid Wing Meningioma with Extraocular Muscle Involvement Mimicking Idiopathic Orbital Inflammation. Ophthal Plast Reconstr Surg. 2016 Feb 12. [QxMD MEDLINE Link].
Walia HS, Grumbine FL, Sawhney GK, Risner DS, Palejwala NV, Emanuel ME, et al. An aggressive sphenoid wing meningioma causing foster kennedy syndrome. Case Rep Ophthalmol Med. 2012. 2012:102365. [QxMD MEDLINE Link].
Frič R, Hald JK, Antal EA. Benign Sphenoid Wing Meningioma Presenting with an Acute Intracerebral Hemorrhage - A Case Report. J Cent Nerv Syst Dis. 2016 Apr 21. 8:1-4. [QxMD MEDLINE Link].
Yang J, Ma SC, Liu YH, Wei L, Zhang CY, Qi JF, et al. Large and giant medial sphenoid wing meningiomas involving vascular structures: clinical features and management experience in 53 patients. Chin Med J (Engl). 2013 Dec. 126 (23):4470-6. [QxMD MEDLINE Link].
Narla S, Uppin MS, Saradhi MV, Sahu BP, Purohit AK, Sundaram C. Assessment of expression of epidermal growth factor receptor and p53 in meningiomas. Neurol India. 2014 Jan-Feb. 62 (1):37-41. [QxMD MEDLINE Link].
Daffner RH, Yakulis R, Maroon JC. Intraosseous meningioma. Skeletal Radiol. 1998 Feb. 27 (2):108-11. [QxMD MEDLINE Link].
Jayaraj K, Martinez S, Freeman A, Lyles KW. Intraosseous meningioma--a mimicry of Paget's disease?. J Bone Miner Res. 2001 Jun. 16 (6):1154-6. [QxMD MEDLINE Link].
Agrawal V, Ludwig N, Agrawal A, Bulsara KR. Intraosseous intracranial meningioma. AJNR Am J Neuroradiol. 2007 Feb. 28 (2):314-5. [QxMD MEDLINE Link].
Tokgoz N, Oner YA, Kaymaz M, Ucar M, Yilmaz G, Tali TE. Primary intraosseous meningioma: CT and MRI appearance. AJNR Am J Neuroradiol. 2005 Sep. 26 (8):2053-6. [QxMD MEDLINE Link].
Rosahl SK, Mirzayan MJ, Samii M. Osteolytic intra-osseous meningiomas: illustrated review. Acta Neurochir (Wien). 2004 Nov. 146 (11):1245-9. [QxMD MEDLINE Link].
Changhong L, Naiyin C, Yuehuan G, Lianzhong Z. Primary intraosseous meningiomas of the skull. Clin Radiol. 1997 Jul. 52 (7):546-9. [QxMD MEDLINE Link].
Chen TC. Primary Intraosseous Meningioma. Neurosurg Clin N Am. 2016 Apr. 27 (2):189-93. [QxMD MEDLINE Link].
Crawford TS, Kleinschmidt-DeMasters BK, Lillehei KO. Primary intraosseous meningioma. Case report. J Neurosurg. 1995 Nov. 83 (5):912-5. [QxMD MEDLINE Link].
Chaves H, Bergamo Y, Paz S, Sanchez F, Vazquez S. Sphenoid wing meningioma behavior on 11C-PiB and 18F-FDG PET. Clin Nucl Med. 2015 Jan. 40 (1):e81-2. [QxMD MEDLINE Link].
Gay E, Vuillez JP, Palombi O, Brard PY, Bessou P, Passagia JG. Intraoperative and postoperative gamma detection of somatostatin receptors in bone-invasive en plaque meningiomas. Neurosurgery. 2005 Jul. 57 (1 Suppl):107-13; discussion 107-13. [QxMD MEDLINE Link].
Backer-Grøndahl T, Moen BH, Torp SH. The histopathological spectrum of human meningiomas. Int J Clin Exp Pathol. 2012. 5 (3):231-42. [QxMD MEDLINE Link].
Louis DN, Perry A, Reifenberger G, von Deimling A, Figarella-Branger D, Cavenee WK, et al. The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary. Acta Neuropathol. 2016 Jun. 131 (6):803-20. [QxMD MEDLINE Link].
Ludwin SK, Rubinstein LJ, Russell DS. Papillary meningioma: a malignant variant of meningioma. Cancer. 1975 Oct. 36 (4):1363-73. [QxMD MEDLINE Link].
Winek RR, Scheithauer BW, Wick MR. Meningioma, meningeal hemangiopericytoma (angioblastic meningioma), peripheral hemangiopericytoma, and acoustic schwannoma. A comparative immunohistochemical study. Am J Surg Pathol. 1989 Apr. 13 (4):251-61. [QxMD MEDLINE Link].
Chamoun R, Krisht KM, Couldwell WT. Incidental meningiomas. Neurosurg Focus. 2011 Dec. 31 (6):E19. [QxMD MEDLINE Link].
Yano S, Kuratsu J, Kumamoto Brain Tumor Research Group. Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg. 2006 Oct. 105 (4):538-43. [QxMD MEDLINE Link].
Oya S, Kim SH, Sade B, Lee JH. The natural history of intracranial meningiomas. J Neurosurg. 2011 May. 114 (5):1250-6. [QxMD MEDLINE Link].
Adlakha A, Rao K, Adlakha H, Perry A, Crotty TB, Scheithauer BW, et al. Meningioma metastatic to the lung. Mayo Clin Proc. 1999 Nov. 74 (11):1129-33. [QxMD MEDLINE Link].
Velnar T, Pregelj R, Limbaeck-Stokin C. Brain meningioma invading and destructing the skull bone: replacement of the missing bone in vivo. Radiol Oncol. 2011 Dec. 45 (4):304-9. [QxMD MEDLINE Link].
Simas NM, Farias JP. Sphenoid Wing en plaque meningiomas: Surgical results and recurrence rates. Surg Neurol Int. 2013 Jul 9. 4:86. [QxMD MEDLINE Link].
DeMonte F, Tabrizi P, Culpepper SA, Suki D, Soparkar CN, Patrinely JR. Ophthalmological outcome after orbital entry during anterior and anterolateral skull base surgery. J Neurosurg. 2002 Oct. 97 (4):851-6. [QxMD MEDLINE Link].
Ringel F, Cedzich C, Schramm J. Microsurgical technique and results of a series of 63 spheno-orbital meningiomas. Neurosurgery. 2007 Apr. 60 (4 Suppl 2):214-21; discussion 221-2. [QxMD MEDLINE Link].
Saeed P, van Furth WR, Tanck M, Freling N, van der Sprenkel JW, Stalpers LJ, et al. Surgical treatment of sphenoorbital meningiomas. Br J Ophthalmol. 2011 Jul. 95 (7):996-1000. [QxMD MEDLINE Link].
Goodwin JW, Crowley J, Eyre HJ, Stafford B, Jaeckle KA, Townsend JJ. A phase II evaluation of tamoxifen in unresectable or refractory meningiomas: a Southwest Oncology Group study. J Neurooncol. 1993 Jan. 15 (1):75-7. [QxMD MEDLINE Link].
Cossu G, Levivier M, Daniel RT, Messerer M. The Role of Mifepristone in Meningiomas Management: A Systematic Review of the Literature. Biomed Res Int. 2015. 2015:267831. [QxMD MEDLINE Link].
Gurberg J, Bouganim N, Shenouda G, Zeitouni A. A case of recurrent anaplastic meningioma of the skull base with radiologic response to hydroxyurea. J Neurol Surg Rep. 2014 Aug. 75 (1):e52-5. [QxMD MEDLINE Link].
Kaley TJ, Wen P, Schiff D, Ligon K, Haidar S, Karimi S, et al. Phase II trial of sunitinib for recurrent and progressive atypical and anaplastic meningioma. Neuro Oncol. 2015 Jan. 17 (1):116-21. [QxMD MEDLINE Link].
Kotecha RS, Jacoby P, Cole CH, Gottardo NG. Morbidity in survivors of child and adolescent meningioma. Cancer. 2013 Dec 15. 119 (24):4350-7. [QxMD MEDLINE Link].

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.

of 5

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: Nothing to disclose.

Coauthor(s)

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.

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.

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.

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.