Planum sphenoidale meningioma [Neurosurgery Wiki]

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====== Planum sphenoidale meningioma =======

//J.Sales-Llopis//

//Neurosurgery Service, Alicante University General Hospital, Alicante, Spain.//
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===== Latest Planum sphenoidale meningioma PubMed-related articles =====


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[[Planum sphenoidale]] [[meningioma]]s are [[anterior skull base meningioma]]s, overlying the area of the [[cribriform plate]] of the [[ethmoid bone]], [[sphenofrontal suture]], and [[planum sphenoidale]]. 

Arise from the flat part of the [[sphenoid bone]] anterior to the [[chiasmatic sulcus]].

The tumors are usually bilateral based on their midline origin, although they can also be unilateral. 


===== Classification =====

[[Planum sphenoidale meningioma classification]].

===== Epidemiology =====

[[Planum sphenoidale meningioma epidemiology]]

===== Clinical features =====

[[Planum sphenoidale meningioma clinical features]].



===== Diagnosis =====

[[Planum sphenoidale meningioma diagnosis]]

===== Differential diagnosis =====

[[Planum sphenoidale meningioma differential diagnosis]].


===== Treatment =====

[[Planum sphenoidale meningioma treatment]]

===== Outcome =====

[[Planum sphenoidale meningioma outcome]]


===== Videos =====

[[Planum sphenoidale meningioma videos]].



===== Systematic reviews =====

[[Planum sphenoidale meningioma systematic reviews]]


===== Case series =====

[[Planum sphenoidale meningioma case series]].

===== Case reports =====

[[Planum sphenoidale meningioma case reports]].

===== General University Hospital of Alicante Cases =====

A 77-year-old female was referred by [[planum sphenoidale meningioma]] with poorly defined [[dizziness]], [[discomfort]], and [[anxiety]] with an increase in [[tremor]] in the right-hand side and a feeling of [[jaw]] tightness, without loss of consciousness or focal neurological deficits. Upon arrival at the Emergency Department, the symptoms had subsided. 

{{::q11209_.jpg?200 |}}

Extra-axial mass located on the right side of the [[planum sphenoidale]] measuring 1.7 x 2.1 x 1.9 cm (CC x AP x TR). This lesion shows intense and homogeneous [[contrast enhancement]], along with associated thickening of the adjacent [[dura]].

It also presents focal [[hyperostosis]] of the [[sphenoid bone]] where it is located and mild hyper [[pneumatization]] of the right [[sphenoid sinus]].

Of note, this lesion has a small intraosseous component in the [[sphenoid]] planum.

Superiorly, it exerts a mass effect on the base of the right [[frontal lobe]], which shows moderate [[vasogenic edema]].

Medially, it contacts the proximal segment A2 of the right [[anterior cerebral artery]], which is displaced to the left.

Laterally, it is related to the right [[anterior clinoid process]].

Inferiorly, the tumor surrounds the right [[internal carotid artery]] superiorly, medially, and laterally, covering approximately 180° of its circumference. The right internal carotid artery does not show a diminished caliber and retains a normal signal void.

The lesion also contacts the inferior cisternal portion of the right [[optic nerve]], which is displaced inferiorly. There doesn't appear to be contact with the optic chiasm.
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[[Supine position]]. Right frontal [[incision]] and right [[lateral supraorbital craniotomy]]. Papery dura mater that disintegrates when lifting the bone flap.

Access to the optic-carotid cistern is achieved, and the tumor implanted in the sphenoid planum is early identified. The tumor base is coagulated, and following the [[arachnoid]] plane, the tumor [[capsule]] is released from the right [[optic nerve]] with its tail extending over it, the right A1 segment, the optic chiasm, and the [[lamina terminalis]]. The lesion is mobilized and removed as a whole.

Arterial bleeding from a pore at the A1-A2 junction requires temporary [[clipping]] of the A1 segment for 2 minutes to facilitate repair with two mini clips in tandem. Pulse of [[indocyanine green]] demonstrates patency of A2 and A1.

Coagulation of the implantation base is performed. The bed is covered with [[Spongostan]]. Semi-hermetic closure with [[Duragen]] and [[Tachosil]].

Bone [[fixation]] with mini [[plate]]s
Subcutaneous closure with absorbable sutures and skin closure with staples.