scholarly journals Giant Medial Sphenoid Wing Meningioma with Hyperostosis Sphenoid Bone : A Case Report

2020 ◽  
Vol 2 (3) ◽  
pp. 16-22
Author(s):  
Faisal ◽  
Tommy Rizky Hutagalung ◽  
Ridha Dharmajaya
Keyword(s):  
Middle Cranial Fossa ◽  
Intimate Relationship ◽  
Tumor Removal ◽  
Blurred Vision ◽  
Anterior Clinoid Process ◽  
Mri Brain ◽  
History Of ◽  
Cranial Fossa ◽  
The Right ◽  
Sphenoid Wing Meningioma

Introduction: Meningiomas of the sphenoid wing make up approximately 15–20% of total cranial meningiomas.Giant medial sphenoid involve the dura of the greater and lesser wings of the sphenoid, the anterior clinoid process,the spheno-orbital bone and the middle cranial fossa, hyperostosis bone was common to found. Surgicalmanagement of giant medial sphenoid is extremely challenging due to their intimate relationship with vital neuralstructures.Case Report : A 40-year-old woman came to the emergency room with complaints of decreased consciousness thathad been experienced since 1 week , recurrent headaches, weakness of the right limb and history of blurred vision. Anon-contrast head ct scan and MRI brain contrast revealed an extra-axial giant mass meningioma in left medialsphenoid wing with hyperostosis bone Craniectomy tumor removal was performed with a subtemporal approachcombined with cranio-orbytozygotomy.Discussion : Hyperostosis is a common phenomenon occuring in different meningiomas with incidence rangingfrom 25 to 49% of meningiomas.it is most commonly seen in sphenoid wing and convexity meningioma . The bonyhyperostosis is of neoplastic nature and is responsible for many of the clinical manifestation of such tumors andhence should be totally drilled to achieve cure and avoid recurrence.Conclusion : Sphenoid wing meningioma en plaque, mainly meningothelial meningiomas, are characterized by theassociated bony hyperostosis that gives them a distinct radiological appearance. Extensive tumor removal is crucialfor correction of proptosis and adequate visual decompression to achieve satisfactory cosmetic and functionaloutcome.

Solitary Fibrous Tumor of the Orbit with Extraorbital Extension: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1241-1245 ◽  
Author(s):  
Satoru Hayashi ◽  
Hideyuki Kurihara ◽  
Junko Hirato ◽  
Tomio Sasaki
Keyword(s):  
Residual Tumor ◽  
Middle Cranial Fossa ◽  
Short Term ◽  
First Case ◽  
Positron Emission ◽  
History Of ◽  
Cranial Fossa ◽  
Mitotic Figures ◽  
Fibrous Tumor ◽  
The Right

ABSTRACT OBJECTIVE AND IMPORTANCE Solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth. CLINICAL PRESENTATION A 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [18F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion. INTERVENTION Resection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor. CONCLUSION The natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.

Bilateral Ossicular Head Dehiscence Into the Middle Cranial Fossa

2018 ◽  
Vol 127 (3) ◽  
pp. 209-212
Author(s):  
Sameer A. Alvi ◽  
Joel W. Jones ◽  
Jim Lin
Keyword(s):  
Ossicular Chain ◽  
Middle Cranial Fossa ◽  
Middle Fossa ◽  
Tegmen Tympani ◽  
Ossicular Chain Reconstruction ◽  
History Of ◽  
Cranial Fossa ◽  
Magnetic Resonance Imaging Mri ◽  
Operative Findings ◽  
The Right

Objectives: To describe a unique case of bilateral dehiscence of the malleus and incus heads into the middle fossa making contact with the temporal lobes, along with its clinical implications. Methods: An analysis of a patient case and review of pertinent literature were performed. Results: A patient with a history of right-sided mastoidectomy for cholesteatoma was evaluated for persistent conductive hearing loss. On computed tomography (CT) and magnetic resonance imaging (MRI), the patient had a complete dehiscence of the tegmen tympani on the right, with ossicular heads being located above the floor of the middle cranial fossa. A similar finding to a milder degree was noted on the left. The patient underwent revision tympanoplasty with mastoidectomy with removal of the incus and ossicular chain reconstruction and middle fossa craniotomy for repair of the right epitympanic dehiscence. Conclusions: We present some of the unique imaging and operative findings involved in an unusual presentation of encephalocele in which the bilateral malleus and incus heads rise above the level of the middle fossa floor.

scholarly journals Antiphospholipid Antibody Syndrome Presenting with Hemichorea

2012 ◽  
Vol 2012 ◽  
pp. 1-2 ◽  
Author(s):  
Yezenash Ayalew ◽  
Fazlihakim Khattak
Keyword(s):  
First Trimester ◽  
Anticardiolipin Antibodies ◽  
Antiphospholipid Antibody ◽  
Antiphospholipid Antibody Syndrome ◽  
Blurred Vision ◽  
Significant Family History ◽  
History Of ◽  
The Right ◽  
Time Of Presentation ◽  
Underlying Pathophysiology

A 25-year-old Bangladeshi lady presented to neurology with a three-month history of involuntary movements of her right arm, associated with loss of power. There was progression to the right leg, and she subsequently developed episodes of slurred speech and blurred vision. At the time of presentation, she was 12 weeks pregnant and the symptoms were reported to have started at conception. Past medical history was unremarkable apart from one first trimester miscarriage and there was no significant family history suggestive of a hereditary neurological condition. MRI of the head revealed no abnormalities but serology showed positive antinuclear antibodies (ANAs) at a titre of 1/400. Further investigations revealed strongly positive anticardiolipin antibodies (>120) and positive lupus anticoagulant antibodies. The patient had a second miscarriage at 19 weeks gestation strengthening the possibility that the chorea was related to antiphospholipid antibody syndrome and she was started on a reducing dose of Prednisolone 40 mg daily and aspirin 300 mg daily. Six months later, she had complete resolution of neurological symptoms. There are several reports of chorea as a feature of antiphospholipid syndrome, but no clear consensus on underlying pathophysiology.

Location of the middle cranial fossa dural plate in patients with chronic otitis media

2014 ◽  
Vol 128 (1) ◽  
pp. 60-63 ◽  
Author(s):  
S Genc ◽  
M G Genc ◽  
I B Arslan ◽  
A Selcuk
Keyword(s):  
Otitis Media ◽  
Chronic Otitis Media ◽  
Middle Cranial Fossa ◽  
Control Group ◽  
Adjacent Structures ◽  
Cranial Fossa ◽  
The Mean ◽  
Bone Scans ◽  
The Right ◽  
And Control

AbstractAim:This study aimed to determine whether or not the middle cranial fossa dural plate is located lower (i.e. more caudally) in patients with chronic otitis media, relative to adjacent structures.Methods:The authors retrospectively investigated computed tomography temporal bone scans of 267 ears of 206 patients who had undergone surgery with a diagnosis of chronic otitis media, together with scans of 222 ears of 111 patients without chronic otitis media. The depth of the middle cranial fossa dural plates was recorded.Results:The mean depth of the middle cranial fossa dural plate was 4.59 mm in the study group and 2.71 mm in the control group (p < 0.001). The middle cranial fossa dural plate was located lower in the right ear in both the study and control groups.Conclusion:The middle cranial fossa dural plate was located lower in patients with chronic otitis media, and in the right ears of both patients and controls. Surgeons should take this low location into consideration, and take extra care, during relevant surgery on patients with chronic otitis media.

Distance from the Labyrinthine Portion of the Facial Nerve to the Basal Turn of the Cochlea Temporal Bone Histopathologic Study

1996 ◽  
Vol 105 (4) ◽  
pp. 323-326 ◽  
Author(s):  
Miriam I. Redleaf ◽  
Richard R. Blough
Keyword(s):  
Facial Nerve ◽  
Internal Auditory Canal ◽  
Middle Cranial Fossa ◽  
Geniculate Ganglion ◽  
Cochlear Function ◽  
Standard Size ◽  
Basal Turn ◽  
History Of ◽  
Cranial Fossa ◽  
Temporal Bones

The middle cranial fossa approach to lesions of the geniculate ganglion and internal auditory canal preserves cochlear function and affords access to the lateral internal auditory canal. The labyrinthine portion of the facial nerve tends to course near the basal turn of the cochlea, just beneath the middle cranial fossa floor, and is usually dissected in this approach. To determine the distance from the labyrinthine portion of the facial nerve to the basal turn of the cochlea, measurements were obtained in the temporal bones of 24 subjects (48 ears) 9 to 76 years of age. These subjects had no history of facial nerve or ear disease, and had normal audiograms. The distances ranged from 0.06 to 0.80 mm, with 21 of 24 right ears (87.5%) showing distances less than the standard size of the smallest diamond drills (0.6 mm), and 18 of 24 (75%) less than 0.5 mm. Incidental note is made of the distance from the geniculate ganglion to the ampulla of the superior semicircular canal, which ranged from 2.06 to 4.88 mm in the 48 specimens. These measurements can serve as guidelines for the surgeon working in the middle cranial fossa.

scholarly journals Adie’s tonic pupil presenting with unilateral photophobia successfully treated with dilute pilocarpine

2020 ◽  
Vol 13 (1) ◽  
pp. e233136
Author(s):  
Hatim Batawi ◽  
Jonathan A Micieli
Keyword(s):  
Symptomatic Relief ◽  
Pharmacological Therapy ◽  
Blurred Vision ◽  
Third Nerve Palsy ◽  
Tonic Pupil ◽  
History Of ◽  
Blurry Vision ◽  
The Right ◽  
Pharmacological Testing ◽  
Left Pupil

A 40-year-old healthy man presented with a 4-month history of photophobia, blurred vision and a right dilated pupil. Examination revealed a right pupil that was not reactive to light but constricted strongly to a near target and slowly redilated when he looked back in the distance. Pharmacological testing with dilute pilocarpine 0.1% resulted in constriction of the right pupil but no change in the left pupil. This also resulted in resolution of his photophobia and blurry vision. Neurological examination was otherwise normal, and a diagnosis of Adie’s tonic pupil was made. The main differential diagnosis to consider for a large pupil is a third nerve palsy, pharmacological mydriasis, tonic pupil and local iris processes, such as iris sphincter tears from trauma. Knowledge of the key features of these conditions can avoid wasted resources from unnecessary testing. Dilute pilocarpine 0.1% three times a day can be considered as a pharmacological therapy for symptomatic relief.

Extradural Devascularization for Resection of a Lesser Sphenoid Wing Meningioma: 2-Dimensional Operative Video

2019 ◽  
Vol 19 (1) ◽  
pp. E49-E49
Author(s):  
David Gallardo-Ceja ◽  
Thalia E Sanchez-Correa ◽  
Diego Mendez-Rosito
Keyword(s):  
Magnetic Resonance ◽  
Complete Removal ◽  
Resonance Imaging ◽  
Large Tumor ◽  
Anterior Clinoid Process ◽  
Operative Case ◽  
History Of ◽  
Head Clamp ◽  
The Right

Abstract We describe the case of a 42-yr-old female patient with a 2-yr history of headache that has progressively worsened. Physical examination revealed no neurological deficit. Magnetic resonance imaging showed a large tumor of the left lesser sphenoid wing that enhanced with gadolinium and produced displacement of the midline and the Sylvian fissure. A thorough analysis of the origin of the tumor was done to establish the surgical strategy. With the patient positioned supine with the head slightly turned to the right side, fixed in a 3-pin head clamp, a pterional craniotomy was performed. Since the origin of the tumor is in the lesser wing an early extradural devascularization of the tumor was done with drilling out all the hyperostotic bone of the lesser sphenoid wing, including the lateral base of the anterior clinoid process. Intradural debulking and resection showed the effect of extradural devascularization with an important decrease in bleeding, allowing the total resection of the tumor. An immediate postop magnetic resonance showed a complete removal of the tumor. The patient presented a paresis of the oculomotor nerve that completely resolved in the 3-mo follow-up. In the following video illustration, we narrate this operative case and highlight the nuances of this approach.1 The patient has given assent and written consent for videos, images, or clinical or genetic information to be published.

WED 142 ‘anti-hu syndrome’ – a case of paraneoplastic sensory neuropathy with encephalitis

2018 ◽  
Vol 89 (10) ◽  
pp. A16.3-A16
Author(s):  
Gupta Srishti ◽  
Jaiswal Amit ◽  
Knopp Michael
Keyword(s):  
Sensory Neuropathy ◽  
Middle Lobe ◽  
Past Medical History ◽  
Small Cell Lung ◽  
Mri Brain ◽  
Brain Scan ◽  
History Of ◽  
Right Middle Lobe ◽  
T2 Hyperintensity ◽  
The Right

A 75-year-old female was referred to the neurology outpatients department with a 6 month history of progressive amnesia and cognitive decline as well as symptoms/signs suggestive of a sensory neuropathy. Past medical history included TIA, cervical spondylosis and recent investigation for hyponatraemia which had been attributed to SIADH. She had been a smoker with a 50+pack year history and consumed minimal alcohol. An MRI brain scan demonstrated bilateral hippocampal T2 hyperintensity. A lumbar puncture demonstrated normal CSF constituents and negative viral PCRs. Full autoimmune and paraneoplastic screening was undertaken which was all normal except for a positive anti-Hu antibody. A CT-TAP highlighted a mass lesion in the right middle lobe of the lung and biopsy confirmed small cell lung cancer (T1aN2M0). A diagnosis of anti-Hu antibody related paraneoplastic syndrome was made and an initial treatment course of IV Methylprednisolone was administered. The patient’s cancer was treated with chemotherapy and adjuvant radiotherapy. Despite a good response with regard to her tumour and hyponatraemia, the patient did not improve significantly cognitively. This case highlights the need for awareness of the combination of symptoms/signs of the described ‘anti-Hu syndrome’ with paraneoplastic sensory neuropathy and/or encephalomyelitis.

Bilateral traumatic facial paralysis associated with unilateral abducens palsy: a case report

2005 ◽  
Vol 119 (2) ◽  
pp. 144-147 ◽  
Author(s):  
Tuncay Ulug ◽  
S Arif Ulubil
Keyword(s):  
Facial Nerve ◽  
Facial Paralysis ◽  
Motor Vehicle ◽  
Bone Fractures ◽  
Middle Cranial Fossa ◽  
Geniculate Ganglion ◽  
Abducens Palsy ◽  
Middle Cranial Fossa Approach ◽  
Cranial Fossa ◽  
The Right

Bilateral traumatic facial paralysis is a very rare clinical condition. Abducens palsy, associated with bilateral traumatic paralysis, is even rarer and has not been well described in the literature. In this report, a 24-year-old male, who developed immediate bilateral facial and right abducens paralyses following a motor vehicle accident, is presented. The patient was referred for neurotologic evaluation 22 days after the injury. Electroneurography (ENoG) demonstrated 100 per cent degeneration at the first examination and, correspondingly, electromyography showed no regeneration potentials. Using high-resolution computed tomography (HRCT), a longitudinal fracture on the right and a mixed-type fracture on the left were identified. The patient had good cochlear reserve on both sides. The decision for surgery was based not on ENoG, because of the delayed referral of the patient, but on the HRCT, which showed clear fracture lines on both sides. The middle cranial fossa approach for decompression of the right facial nerve was performed on the 55th day following the trauma, and a combined procedure using the middle cranial fossa and transmastoid approaches was applied for decompression of the left facial nerve on the 75th day following the trauma. On the right, there was dense fibrosis surrounding the geniculate ganglion and the proximal tympanic segment whereas, on the left, bone fragments impinging on the geniculate ganglion, dense fibrosis surrounding the geniculate ganglion, and a less extensive fibrotic tissue surrounding the pyramidal segment were encountered. There were no complications or hearing deterioration. At the one-year follow up, the patient had House-Brackmann (HB) grade 1 recovery on the right, and HB grade 2 recovery on the left side, and the abducens palsy regressed spontaneously. The middle cranial fossa approach and its combinations can be performed safely in bilateral temporal bone fractures as labyrinthine sparing procedures if done on separate occasions.

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