Presentation
Chronic dizziness and headache.
Patient Data
Extensive non-enhancing hyperostosis of the left anterior clinoid process, extending into the planum sphenoidale and the left lesser sphenoid wing, associated with avidly enhancing adjacent dural coverings and extensive subdural calcifications, particularly in the left inferior temporal region and the left tentorium, with homogenous enhancement of the left cavernous sinus, encasing the cavernous segment of the left internal carotid artery with no significant arterial luminal narrowing.
Findings suggest a meningioma en plaque of the left sphenoidal ridge.
Compared to the right side, the left optic canal appears to be slightly narrowed secondary to adjacent hyperostosis. No left optic nerve altered signal.
Incidental crescentiform left frontoparietal extra-axial collection of CSF intensity on all sequences, suggestive of a frontoparietal subdural hygroma.
Hyperostosis of the left anterior clinoid process, planum sphenoidale and left lesser sphenoid wing.
Thick subdural calcifications in the left anterior temporal region and along the left tentorium, separated from the hyperostosing bone by a thin hypodense curvilinear interface, corresponding to the dural coverings seen on MRI.
Minimal resultant narrowing of the left optic canal.
Case Discussion
Commonly affecting the sphenoidal ridge, en plaque meningiomas are rare tumors that envelop the inner table of the skull, infiltrating the adjacent dura and bone, with resultant hyperostosis.
They are usually relatively small, flat, slow-growing tumors, triggering adjacent bone hyperostosis, which may be the cause of patient's symptoms.
On CT scan, hyperostosic bone secondary to a meningioma en plaque usually demonstrates inward bowing. A hypoattenuating dural line/interface may be seen between the hyperostotic bone and subdural calcifications.
Plausible differential diagnoses my include primary intraosseous meningioma, fibrous dysplasia, osteoma, Paget's disease, neuroblastoma or dural metastases.
Entire resection is difficult, with a higher probability of recurrence or malignant transformation.
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