Presentation
Left-sided proptosis, swollen left optic disc, visual field defect.
Patient Data
Left-sided proptosis. Hyperostosis centered upon the left sphenoid wing with involvement of the body and clinoid process with associated dural thickening and enhancement within the left middle cranial fossa extending along the cavernous sinus and towards the orbital apex. The posterior aspect of the left orbit including the orbital apex is narrowed, and the left optic canal is also slightly effaced though this would merit further assessment with MRI. No additional intracranial abnormality is identified.
Comment: Left sphenoid hyperostosis and dural thickening and enhancement. Appearances are suggestive of a predominantly intraosseous sphenoid meningioma with associated narrowing of the left orbital apex and the optic canal.
Extensive skull base meningioma involving the left sphenoid, ethmoid, and zygomatic bones. The bony hyperostosis is best illustrated on recent CT. Although there is some dural enhancement, there is little in the way of intracranial soft tissue and there is no parenchymal reaction.
Although there is an inferolateral deviation of the left orbital apex due to the bony hyperostosis, there is no evidence of optic nerve entrapment as the nerve returns a normal signal. No edema within the extraocular muscle attachments.
No other lesions are identified.
No significant soft tissue component within the infratemporal fossa.
Summary: Extensive skull base meningioma with dural enhancement but no significant soft tissue involvement.
Case Discussion
This is a case of intraosseous meningioma which has affected the orbital apex with resultant visual disturbance. This case demonstrates the more common appearance of diffuse sclerotic change, rather than lytic change.
The patient proceeded to cranioplasty and reconstruction, the subsequent pathology confirmed intraosseous meningioma WHO grade 1.
Case courtesy of Dr Helen Cliffe.
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