Planum sphenoidale meningioma
66-year-old female presenting with a six-month history of a headache and deteriorating vision.
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Scans were performed with and without intravenous contrast, demonstrating a vividly enhancing 3.9 x 4.2 cm diameter mass arising from the planum sphenoidale and floor of the anterior cranial fossa. There is significant vasogenic oedema within the right frontal lobe extending across the corpus callosum into the left frontal lobe. Sphenoid bony infiltration and hyperostosis evident. The findings are typical of an anterior cranial fossa meningioma.
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A 4.1 x 4.2 x 2.7cm T1 and T2 isointense to brain non diffusion restricting floridly enhancing lesion with a small central area of non-enhancement without blooming has a broad based attachment with dural tail to the posterior floor of the anterior cranial fossa, moderately compressing and superiorly displacing the the inferior frontal lobes, right greater than left, with effacement of the frontal horn of the right lateral ventricle and midline shift of 8 mm to the left. Moderate vasogenic oedema in predominantly the right frontal white matter, crossing corpus callosum to involve the left frontal white matter. The mass lies anterior to the pituitary stalk, touching the pituitary supero-anteriorly. The origin of the right MCA touches the posterior aspect of this mass with normal flow void. The supraclinoid right ICA appears to be surrounded by more than 180 degrees; in the coronal post contrast sequence. Chiasm not well seen. No definite involvement of the orbital apex and cavernous sinuses. Meckel's caves appear uninvolved. Involvement of the roof of the sphenoid sinus and floor of the anterior cranial fossa however suspected.
Conclusion: Findings most in keeping with a large planum sphenoidale meningioma with significant positive mass effect.
The patient underwent preoperative tumor embolization followed by a right pterional craniotomy and tumor resection.
Histopathology: Paraffin sections show a moderately hypercellular meningioma with a well-developed syncytial architecture. Scattered calcified Psammoma bodies are also noted. Tumour cells have regular nuclear features. A very occasional mitotic figure is identified. No areas of necrosis are seen and there is no brain invasion.
DIAGNOSIS: "Brain tumour": Meningioma
This case illustrates the typical radiological findings of a planum sphenoidale meningioma.
Planum spheonoidale meningiomas account for 5-10% of all intracranial meningiomas. They are typically slow-growing tumors, explaining why some patients remain asymptomatic and, therefore, un-diagnosed for extended periods of time. The ensuing growth of the extra-axial neoplasm can cause displacement of the optic apparatus resulting in visual disturbances. It is, therefore, imperative that patient undergoes formal neuro-ophthalmological testing before any surgical intervention. A headache, although present in many patients with this neoplasm, is a non-specific finding.
Neuroimaging characteristics on CT include a homogenously and avidly contrast-enhancing, extra-axial mass, with a well-defined border and broad dural attachment and/or dural tail. The tumor is associated with moderate circumferential edema and mass effect. There may be an area of central calcification within the tumour and hyperostosis of adjacent bony structures may be evident.
On MRI, the meningioma appears hypo to isointense on T1-weighted imaging and possesses variable signal intensity on T2-weighted images. Gadolinium MR imaging demonstrates intense homogeneous or heterogeneous-enhancement of the tumor, with well-circumscribed margins.
Case Courtesy of Associate Professor Pramit Phal
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