Management of bone-invasive, hyperostotic sphenoid wing meningiomas

Bikmaz, Kerem; Mrak, Robert E.; Al‐Mefty, Ossama

doi:10.3171/jns-07/11/0905

Cited by 148 publications

(119 citation statements)

References 36 publications

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“…In addition to the dural-based mass, meningiomas promote hyperostosis of adjacent bone in up to 49% of all tumors [26,27]. Histopathology of hyperostotic bone demonstrates infiltration of meningothelial tumors cells within Haversian canals, suggesting that bony disease must be addressed to completely resect the tumor [28][29][30]. The rate of tumor infiltration in bone may be as high as 69% in skull base tumors [30].…”

Section: Origins Of Meningiomasmentioning

confidence: 99%

Stereotactic radiosurgery for benign meningiomas

et al. 2011

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Meningiomas are the second most common primary tumor of the brain. Surgical resection is the preferred treatment for easily accessible tumors that can be safely removed. However, many tumors arise deep within the skull base making complete surgical resection difficult or impossible. Stereotactic radiosurgery is a highly effective alternative to surgical resection that has been used as a primary therapy for benign meningiomas as well as an adjuvant treatment for residual or recurrent tumors. The 5-year tumor control rates for stereotactic radiosurgery are equivalent to gross-total resection with lower morbidity than surgery, especially for skull base lesions. Additionally, adjuvant treatment of subtotally resected tumors results in tumor control rates equivalent to gross-total resection. Stereotactic radiosurgery has been used extensively for the treatment of small and medium sized skull base meningiomas. This technique has also been applied to large meningiomas and superficial tumors such as convexity and parasagittal meningiomas. However, multiple studies demonstrate that tumor control is decreased for superficial lesions and with increasing tumor size. In addition, radiation toxicity increases with increasing tumor size and superficial location. Based on a thorough review of the literature, stereotactic radiosurgery should be considered the primary treatment for skull base meningiomas with high surgical risk and in cases of superficial meningiomas where surgery is contraindicated.

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Section: Origins Of Meningiomasmentioning

confidence: 99%

Stereotactic radiosurgery for benign meningiomas

et al. 2011

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“…One small series of five patients with non-Hodgkin lymphoma of the skull base confirmed the difficulty in differentiating these neoplasms but suggested that bone enhancement without hyperostotic reaction and cavernous sinus invasion without narrowing of the carotid artery lumen could be helpful in distinguishing lymphoma from meningioma [9]. The latter is typically characterized by hyperostotic bone involvement which actually represents invasion of the bone by the tumor [10] and does not generally preserve the carotid artery lumen. These features appear to apply to our patient as radiography did not show a hyperostotic reaction to bone involvement and demonstrated delicate sparing of the carotid artery lumen in both MRI studies taken 8 weeks apart, despite growth of the tumor over this period.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system lymphoma presenting as trigeminal neuralgia: A diagnostic challenge

Ang

Khanna

Walcott

et al. 2015

Journal of Clinical Neuroscience

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We describe an atypical man with diffuse large B cell lymphoma localized to the sphenoid wing and adjacent cavernous sinus, initially presenting with isolated ipsilateral facial pain mimicking trigeminal neuralgia due to invasion of Meckel’s cave but subsequently progressing to intra-axial extension and having synchronous features of systemic lymphoma. Primary central nervous system lymphoma is uncommon, accounting for approximately 2% of all primary intra-cranial tumors, but its incidence has been steadily increasing in some groups [1]. It usually arises in periventricular cerebral white matter, reports of lymphoma in extra-axial regions are rare [2]. This man highlights the importance of maintaining lymphoma in the differential diagnosis of tumors of the skull base presenting with trigeminal neuralgia-like symptoms.

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“…These regions are often due to actual invasion of the bone with tumor, and aggressive surgical removal, when possible, is recommended[3]. Management of such lesions where the osteoblastic skull base may not be resectable from a purely endoscopic endonasal resection should include consideration for a bifrontal craniotomy to achieve higher rates of bony removal; although a gross total resection of the bony component could not be achieved in this case, maximum bony resection was performed without neurovascular injury through this approach.…”

Section: Discussionmentioning

confidence: 99%

Hyperostotic Esthesioneuroblastoma

Ramanathan¹,

Germanwala²

2013

Journal of Case Reports in Medicine

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Esthesioneuroblastomas are rare, soft-tissue tumors that can often extend from the sinonasal cavity into the intracranial and orbital space. Prognosis depends upon the histological grade and location/extent of the tumor. Treatment often consists of maximum surgical resection followed by adjuvant chemoradiation therapy. We present a case of a patient with esthesioneuroblastoma accompanied by an extensive osteoblastic reaction leading to significant hyperostosis along the skull base. His presenting symptoms included diplopia, and imaging revealed invasion of the orbital and intracranial spaces. Although a gross total resection of the soft tissue component of the tumor was achieved, a complete removal of the involved hyperostotic skull base could not be performed despite endoscopic endonasal and bifrontal craniotomy approaches in the same operative setting. Symptomatically, the patient improved and went on to receive chemoradiation therapy; he remains clinically and radiographically stable at 12 months. Investigation into the genetics and immunohistochemistry of this rare, hyperostotic variant of estheioneuroblastoma may provide details regarding its aggressive nature.

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Management of bone-invasive, hyperostotic sphenoid wing meningiomas

Cited by 148 publications

References 36 publications

Stereotactic radiosurgery for benign meningiomas

Stereotactic radiosurgery for benign meningiomas

Central nervous system lymphoma presenting as trigeminal neuralgia: A diagnostic challenge

Hyperostotic Esthesioneuroblastoma

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