Sphenoid Wing Meningioma
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MENINGIOMA
A meningioma is a type of brain tumor that develops from the tissue encasing the brain and spinal cord. Meningiomas are benign and are more frequently found in women over 50 years old. Roughly 20% of cranial meningiomas are located in the part of the skull that forms the floor of the eye socket (sphenoid wing). They are thought to be linked to gene mutations that control cell growth and division.
DIAGNOSIS OF ORBITAL MENINGIOMA
A patient’s medical history and physical conditions help in the diagnosis of sphenoid wing meningiomas. Neuroimaging through CT scans and MRIs provide more diagnostic information. Tumors growing in the clinoidal area may cause optic nerve damage along with the following symptoms: decreased visual acuity, progressive color vision loss, impaired visual field, and pupillary abnormalities. If the tumor goes untreated and continues to grow and put pressure on the optic nerve, it is possible that all vision will be lost. Proptosis and palpebral swelling can occur along with cranial nerve damage in the cavernous sinus. This can lead to diplopia, particularly in cranial nerve VI. Patients with damage to cranial nerve VI may experience pain and skull sensitivity. Note that Horner’s syndrome is possible when sympathetic fibers are impacted.
CLASSIFICATION OF ORBITAL MENINGIOMA
Tumors found in the external third of the sphenoid are either en-plaque or globoid meningiomas. En plaque tumors lead to slow progressive proptosis with the eye angled downward (due to reactive orbital hyperostosis). Globoid meningiomas lead to increased intracranial pressure, which results in headaches and a swollen optic disc. Following a physical exam, CT or MRI may be ordered to confirm the diagnosis. Discovery of stretched arteries may point to vascular involvement, which may lead to embolization during surgery.
TREATMENT OF ORBITAL MENINGIOMA
Gamma knife radiation and microscopic surgery are treatment options. Given their encapsulation, meningioma tumors are sometimes addressed through radiosurgery, as they can be resected with little risk of damaging blood vessels or cranial nerves. If total surgical excision is not possible, external beam radiation reduces the likelihood of growth recurrence. Most meningiomas grow slowly and do not metastasize. Sometimes, it is best to observe and image these tumors instead of opting for surgical removal.
