Sphenoid wing meningioma
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Left-sided poor vision and proptosis
There is an extra-axial solid appearing avidly enhancing mass lesion with a large dural tail along the left medial sphenoid ridge and left anterior clinoid process. Anteriorly, the mass is extending into the optic foramen and retrobulbar space. Medially, the lesion is extending into the left cavernous sinus and sellar region, encasing the supraclinoid portion of the left internal carotid artery. Posteriorly and laterally, the mass is exerting compressive effect over the left temporal lobe.
Left-sided proptosis with optic nerve tortuosity is noted.
Area of encephalomalacia with surrounding gliosis is noted in the right parietal lobe, consistent with the sequela of previous ischemic infarction. Multiple T2/FLAIR focal high signal intensities are noted within the periventricular deep white matter, representing small vessel chronic ischemic changes.
En plaque meningioma constitutes up to 9% of all meningiomas, most of which are located along the sphenoid ridge. There is extensive dural involvement with usual extracranial extension. Proptosis and visual field impairment are the most common symptoms of the patients.
Dr. Farhad Farzam has also contributed to this case.