Greater wing of sphenoid, the home for aneurysmal bone cysts: a case report

Background Finding an aneurysmal bone cyst in the skull is rare and for a neurosurgeon to come across such lesions in the sphenoid bone with orbital extension is even rarer. Case presentation We report a case of a 16-year female who presented with a three-month history of headache, proptosis, and deterioration of vision. Pre-operative imaging studies which included NCCT head and MRI brain, suggested the lesion to be an aneurysmal bone cyst of the greater wing of the sphenoid, with extension into the orbit. Intraoperative findings did corroborate with the preoperative imaging findings and were again confirmed later from the histopathology report. Conclusion Aneurysmal bone cysts of sphenoid bone with orbital extension, though rare, can be excised completely, without hampering the cosmesis. Being benign, patients can have a prolonged recurrence-free period if the lesion is completely excised.

THE VARIABILITY AND THE RATIO OF THE PITUITARY GLAND AND PITUITARY FOSSA LINEAR PARAMETERS DEPENDING ON THE SKULL BASE ANGLE

Details of the morpho- & topometric variability of the skull elements and soft tissue formations in the area of the sphenoid bone body, as well as their relationship, serve as the basis for the choice of proper surgical accesses to the respective area. The aim of this study was to identify the typical variability of morphometric parameters and the volume ratio between the pituitary gland and the Turkish saddle pituitary fossa in mature age adults. The method of computer craniometry (involving 100 MRI of people of the first and second periods of their mature age, 22–60) was employed to study the typical variability of the pituitary fossa and pituitary gland linear parameters, regardless of gender. The obtained data revealed that the regularity of morphometric variability and the volume ratio of the pituitary gland and the pituitary fossa depend on the skull base bending angle.

Primary Ewing sarcoma of the sphenoid bone with infrasellar spread in a 17-year-old patient: case report and literature review

We performed retrospective analysis of publications describing cases of Ewing sarcoma of the skull base with exceedingly rare locations (including the area of the sphenoid bone, its wings, sinus, and adjacent structures). Ewing sarcoma is usually diagnosed in children. The peak incidence is registered in patients aged 10–15 years, whereas adults and children under 5 years of age are very unlikely to develop this disease. In this article, we also report a case of Ewing sarcoma of the skull bones affecting the sphenoid bone and sphenoid sinus. The patient has undergone surgery followed by chemoradiotherapy. High invasion potential (tumor spread in several directions), high malignancy, and compression of the adjacent structures of the brain make the analysis of Ewing sarcoma located in areas that cannot be easily approached particularly interesting for neurosurgeons, since surgery is the main treatment option for such patients.

U mỡ trong xương bướm: một trường hợp hiếm gặp

TÓM TẮT U mỡ trong xương là khối u lành tính hiếm gặp, thường gặp ở các xương dẹt, hiếm gặp ở xương nền sọ, đặc biệt là xương bướm. Trong đa số các trường hợp, u mỡ trong xương bướm thường được phát hiện tình cờ qua chụp cắt lớp vi tinh (CLVT) hoặc cộng hưởng từ (CHT) sọ não. Đây là một khối u phát triển chậm, ít gây ra triệu chứng, một số trường hợp gây triệu chứng khi khối u to chèn ép vào cấu trúc lân cận như tuyến yên hoặc dây thần kinh thị. Trong bài này, chúng tôi báo cáo một trường hợp u mỡ trong xương bướm không triệu chứng được phát hiện tình cờ và được chẩn đoán dựa vào phim chụp cộng hưởng từ sọ não. Bệnh nhân được khuyến nghị theo dõi định kỳ bằng cộng hưởng từ mà không phải tiến hành bất kỳ phương pháp điều trị nào. Từ khóa: U mỡ, xương bướm, MRI, cộng hưởng từ sọ não, chẩn đoán hình ảnh. ABSTRACT INTRAOSSEOUS LIPOMA OF SPHENOID BONE: A RARE CASE REVIEW Intraosseous lipoma is very rare, usually benign tumor of flat bones. The incidence of an intraosseous lipomalocated basal skull bones is extremely rare, especially in sphenoid bone. Radiological imaging techniques such as magnetic resonance imaging (MRI) and computed tomography (CT) are used to detect the intraosseous lipoma by accident. These tumors are slow growing and usually asymptomatic, in some cases causing symptoms when the large tumor presses on nearby structures such as pituitary gland or the optic nerve. We present a rare case of lipomaof the sphenoid bone discovered incidentally with brain magnetic resonance imaging. The patient has been followed-up by magnetic resonance imaging without the need for surgery. Keywords: Intraosseous lipoma, sphenoid bone, MRI, brain MRI, diagnostic radiology

The chondrocranial key: Fetal and perinatal morphogenesis of the sphenoid bone in primates

The sphenoid bone articulates with multiple basicranial, facial, and calvarial bones, and in humans its synchondroses are known to contribute to elongation of the skull base and possibly to cranial base angulation. Its early development (embryological, early fetal) has frequently been studied in a comparative context. However, the perinatal events in morphogenesis of the sphenoid have been explored in very few primates. Using a cross-sectional age sample of non-human primates (n=39; 22 platyrrhines; 17 strepsirrhines), we used microcomputed tomographic (µCT) and histological methods to track age changes in the sphenoid bone. In the midline, the sphenoid expands its dimensions at three growth centers, including the sphenooccipital, intrasphenoidal (ISS) and presphenoseptal (PSept) synchondroses. Bilaterally, the alisphenoid is enlarged via appositional bone growth that radiates outward from cartilaginous parts of the alisphenoid during midfetal stages. The alisphenoid remains connected to the basitrabecular process of the basisphenoid via the alibasisphenoidal synchondrosis (ABS). Reactivity to proliferating cell-nuclear antigen is observed in all synchondroses, indicating active growth perinatally. Between mid-fetal and birth ages in Saguinus geoffroyi, all synchondroses decrease in the breadth of proliferating columns of chondrocytes. In most primates, the ABS is greatly diminished by birth, and is likely the earliest to fuse, although at least some cartilage may remain by at least one-month of age. Unlike humans, no non-human primate in our sample exhibits perinatal fusion of ISS. A dichotomy among primates is the orientation of the ABS, which is more rostrally directed in platyrrhines. Based on fetal Saguinus geoffroyi specimens, the ABS was initially oriented within a horizontal plane, and redirects inferiorly during late fetal and perinatal stages. These changes occur in tandem with forward orientation of the orbits in platyrrhines, combined with downward growth of the midface. Thus, we postulate that active growth centers direct the orientation of the midface and orbit before birth.

A single-center experience with giant cell tumors of sphenoid bone and clivus

Objective: To present pathologic, clinical, and treatment findings for giant cell tumors (GCTs) of sphenoid bone and clivus. Methods: We describe the optimal treatment algorithm in patients with a histopathologic diagnosis of bone GCT by presenting the effects of denosumab treatment in both pediatric and adult patients with GCT undergoing endoscopic transnasal surgery. Clinicopathologic correlation is crucial for the differential diagnosis of GCT and the choice of treatment modality. Conclusion: GCT of bone is a local aggressive tumor that accounts for about 3%–7% of all bone tumors. GCTs located in the cranium are extremely uncommon neoplasms. There are no defined guidelines for the treatment of GCTs in skull base. Following surgical resection of the tumor, the addition of denosumab treatments to radiotherapy has a significant role in preventing the recurrence of GCT and in promoting regression of residual tumor size.

Four-dimensional digital subtraction angiography for exploration of intraosseous arteriovenous fistula in the sphenoid bone

Background: Intraosseous arteriovenous fistula (AVF) is a rare clinical entity that typically presents with symptoms from their effect on surrounding structures. Here, we report a case of intraosseous AVF in the sphenoid bone that presented with bilateral abducens palsy. Case Description: A previously healthy man presented with tinnitus for 1 month, and initial imaging suspected dural AVF of the cavernous sinus. Four-dimensional digital subtraction angiography (4D-DSA) imaging and a three-dimensional (3D) fused image from the bilateral external carotid arteries revealed that the shunt was in a large venous pouch within the sphenoid bone that was treated through transvenous coil embolization. His symptoms improved the day after surgery. Conclusion: This is a case presentation of intraosseous AVF in the sphenoid bone and highlights the importance of 4D-DSA and 3D fused images for planning the treatment strategy.