Management of bone-invasive, hyperostotic sphenoid wing meningiomas

View More View Less
  • 1 Departments of Neurosurgery and
  • 2 Neuropathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

Object

The hyperostosis frequently associated with sphenoid wing meningiomas is actual invasion of bone by the tumor. The intracranial portion of the tumor is usually thin with en plaque spread, and the tumor tends to invade the orbit through the superior orbital fissure.

Methods

The authors reviewed the records of 67 patients with sphenoid wing meningiomas who underwent surgery at the University of Arkansas for Medical Sciences between 1994 and 2004. In all 67 cases, the surgery was performed by the senior author. Seventeen of the patients had the distinguishing characteristics of hyperostotic sphenoid wing meningiomas—extensive bone invasion, en plaque dural involvement, and a minimal intracranial mass with minimal orbital involvement. In all patients, hyperostosis was determined on the basis of preoperative neuroimaging. Histopathological evaluation of bone specimens was performed in 14 cases. Estrogen and progesterone receptor expression and Ki 67 labeling were evaluated in all specimens. Chromosome analysis was performed in all tumors resected since 2001 (seven cases). Particular attention was paid to removing all involved bone and dura mater.

Results

Total removal was achieved in 14 cases (82.3%), with only one recurrence (7.1%) over a mean follow-up period of 36 months (range 5–72 months). Radical resection was followed by cranioorbital reconstruction to prevent enophthalmos and to obtain good cosmetic results. No deaths or serious complications occurred in association with surgery. Proptosis was corrected in all cases and visual acuity improved in seven (70%) of 10 cases. Revision of the orbital reconstruction was required because of postoperative enophthalmos (two cases) or restricted postoperative ocular movement (one case).

Conclusions

Sphenoid wing meningiomas frequently invade bone, although such invasion does not represent malignancy. These lesions are generally histologically benign. Total removal with a prospect for cure and visual preservation should be the goal of treatment. This requires extensive drilling of the invaded bone and extensive excision of the involved dura. When the optic canal is involved, it should be decompressed. Extensive bone resection should be followed by cranioorbital reconstruction for good cosmesis and to prevent enophthalmos.

Abbreviations used in this paper:CT = computed tomography; MR = magnetic resonance; WHO = World Health Organization.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Ossama Al-Mefty, M.D., Department of Neurosurgery, University of Arkansas for Medical Sciences, 4301 West Markham Street, Slot 507, Little Rock, Arkansas 72205–7199. email: keelandamye@uams.edu.
  • 1

    Adegbite AB, , Khan MI, , Paine KW, & Tan LK: The recurrence of intracranial meningiomas after surgical treatment. J Neurosurg 58:5156, 1983

    • Search Google Scholar
    • Export Citation
  • 2

    Al-Mefty O: The cranio-orbital zygomatic approach for intracranial lesions. Contemp Neurosurg 14:16, 1992

  • 3

    Al-Mefty O, & Fox JL: Superolateral orbital exposure and orbital reconstruction. Surg Neurol 23:609613, 1985

  • 4

    Al-Mefty O, , Kadri PA, , Pravdenkova S, , Sawyer JR, , Stangeby C, & Husain M: Malignant progression in meningioma: documentation of a series and analysis of cytogenetic findings. J Neurosurg 101:210218, 2004

    • Search Google Scholar
    • Export Citation
  • 5

    Basso A, , Carrizo AG, , Kreutel A, , Martino A, , Cerisola J, & Torrieri A, : Primary intraorbital meningiomas. Schmidek HH: Meningiomas and Their Surgical Management Philadelphia, WB Saunders, 1991. 311323

    • Search Google Scholar
    • Export Citation
  • 6

    Bonnal J, , Thibault A, , Brotchi J, & Born J: Invading meningiomas of the sphenoid ridge. J Neurosurg 53:587599, 1980

  • 7

    Brissaud P, & Lereboullet P: Deux cas d'henicraniose. Rev Neurol 11:537540, 1903

  • 8

    Castellano F, , Guidetti B, & Olivecrona H: Pterional meningiomas en plaque. J Neurosurg 9:188196, 1952

  • 9

    Chan RC, & Thompson GB: Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg 60:5260, 1984

    • Search Google Scholar
    • Export Citation
  • 10

    Cushing H: The cranial hyperostoses produced by meningeal endotheliomas. Arch Neurol Psychiatry 8:139154, 1922

  • 11

    Cushing H, & Eisenhardt L: Meningiomas: Their Classification, Regional Behaviour, Life History, and Surgical End Results Springfield, IL, Charles C Thomas, 1938

    • Search Google Scholar
    • Export Citation
  • 12

    Derome PJ, & Guiot G: Bone problems in meningiomas invading the base of the skull. Clin Neurosurg 25:435451, 1978

  • 13

    de Jésus O, & Toledo MM: Surgical management of meningioma en plaque of the sphenoid wing. Surg Neurol 55:265269, 2001

  • 14

    De Santis A, , Rampini P, & Villani R: Hyperostosing meningiomas of the cranial vault. J Neurosurg Sci 24:151154, 1980

  • 15

    Eisenberg MB, , Al-Mefty O, , DeMonte F, & Burson GT: Benign nonmeningeal tumors of the cavernous sinus. Neurosurgery 44:949955, 1999

  • 16

    Frazier CH, & Alpers BJ: Meningeal fibroblastomas of the cerebrum. Arch Neurol Psychiatry 29:935989, 1933

  • 17

    Freedman H, & Forster FM: Bone formation and destruction in hyperostoses associated with meningiomas. J Neuropathol Exp Neurol 7:6980, 1948

    • Search Google Scholar
    • Export Citation
  • 18

    Heick A, , Mosdal C, , Jørgensen K, & Klinken L: Localised cranial hyperostosis of meningiomas: a result of neoplastic enzymatic activity?. Acta Neurol Scand 87:243247, 1993

    • Search Google Scholar
    • Export Citation
  • 19

    Jääskeläinen J: Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26:461469, 1986

    • Search Google Scholar
    • Export Citation
  • 20

    Kadri PA, & Al-Mefty O: The anatomical basis for surgical preservation of temporal muscle. J Neurosurg 100:517522, 2004

  • 21

    Kallio M, , Sankila R, , Hakulinen T, & Jääskälinen J: Factors affecting operative and excess long-term mortality in 935 patients with intracranial meningioma. Neurosurgery 31:212, 1992

    • Search Google Scholar
    • Export Citation
  • 22

    Kim KS, , Rogers LF, & Goldblatt D: CT features of hyperostosing meningioma en plaque. AJR Am J Roentgenol 149:10171023, 1987

  • 23

    Kim KS, , Rogers LF, & Lee C: The dural lucent sign: characteristic sign of hyperostosing meningioma en plaque. AJR Am J Roentgenol 141:12171221, 1983

    • Search Google Scholar
    • Export Citation
  • 24

    Kwee IL, , Nakada T, & St. John JN: Triple fossa metastasis of prostate cancer. Neurosurgery 13:584586, 1983

  • 25

    Lindsberg PJ, , Tatlisumak T, , Tienari J, & Brander A: Bilateral sphenoid wing metastases of prostate cancer presenting with extensive brain edema. Eur J Neurol 6:363366, 1999

    • Search Google Scholar
    • Export Citation
  • 26

    MacCarty CS: Meningiomas of the sphenoidal ridge. J Neurosurg 36:114120, 1972

  • 27

    Maroon JC, , Kennerdell JS, , Vidovich DV, , Abla A, & Sternau L: Recurrent spheno-orbital meningioma. J Neurosurg 80:202208, 1994

  • 28

    Mathiesen T, , Lindquist C, , Kihlström L, & Karlsson B: Recurrence of cranial base meningiomas. Neurosurgery 39:29, 1996

  • 29

    Miller DC: Predicting recurrence of intracranial meningiomas. A multivariate clinicopathologic model—interim report of the New York University Medical Center Meningioma Project. Neurosurg Clin N Am 5:193200, 1994

    • Search Google Scholar
    • Export Citation
  • 30

    Mirimanoff RO, , Dosoretz DE, , Linggood RM, , Ojemann RG, & Martuza RL: Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 62:1824, 1985

    • Search Google Scholar
    • Export Citation
  • 31

    Nakasu S, , Nakasu Y, , Nakajima M, , Matsuda M, & Handa J: Preoperative identification of meningiomas that are highly likely to recur. J Neurosurg 90:455462, 1999

    • Search Google Scholar
    • Export Citation
  • 32

    Obeid F, & Al-Mefty O: Recurrence of olfactory groove meningiomas. Neurosurgery 53:534543, 2003

  • 33

    Olmsted WW, & McGee TP: Prognosis in meningioma through evaluation of skull bone patterns. Radiology 123:375377, 1977

  • 34

    Pearl GS, , Takei Y, , Parent AD, & Boehm WM Jr: Primary intraosseous meningioma presenting as a solitary osteolytic skull lesion: case report. Neurosurgery 4:269270, 1979

    • Search Google Scholar
    • Export Citation
  • 35

    Pieper DR, , Al-Mefty O, , Hanada Y, & Buechner D: Hyperostosis associated with meningioma of the cranial base: secondary changes or tumor invasion. Neurosurgery 44:742747, 1999

    • Search Google Scholar
    • Export Citation
  • 36

    Pompili A, , Derome PJ, , Visot A, & Guiot G: Hyperostosing meningiomas of the sphenoid ridge—clinical features, surgical therapy, and long-term observations: review of 49 cases. Surg Neurol 17:411416, 1982

    • Search Google Scholar
    • Export Citation
  • 37

    Sosman MC, & Putnam TJ: Roentgenological aspects of brain tumours: meningiomas. AJR Am J Roentgenol 13:112, 1925

  • 38

    Spiller WG: Cranial hyperostosis associated with underlying meningeal fibroblastoma. Arch Neurol Psychiatry 21:637640, 1929

  • 39

    Spiller WG: Hemicraniosis and cure of brain tumor by operation. JAMA 49:20592065, 1907

Metrics