Al-Azhar Neurosurgery

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Al-Hussein university hospital , Al-Sayyed Galal hospital

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Case 4

Case 4 Meningioma En-plaque

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Figure 4.1: MRI of the patient: Axial T1, Axial T2 and FLAIR.

Clinical presentation

  • Female patient, 48 years old.
  • The condition started 7 years ago when the patient developed right eye proptosis.
  • 1 year ago, proptosis progressed and was associated with unilateral diminution of vision in the right eye.
  • Fundus: Bilateral pale optic discs.
  • The proptosis is not pulsatile and no bruit is heard.
  • Q1: What is the characteristic feature of sphenoorbital meningioma?
  • It is characterized by hyperostosis involving the sphenoid bone, pterion, orbital wall, zygomatic bone, temporal bone, and middle cranial fossa, leading to bone thickening that may compress orbital structures. Typically, patients present with proptosis, as shown in this case. Moreover, it is sometimes associated with a sheet of soft meningioma tissue, which may be located in the orbit or the temporal lobe.
  • Q2: What is the cause of the diminution of vision in this patient?
  • It may be due to soft tissue swelling in the orbit, which compresses the optic nerve or affects its blood supply. Moreover, it may be due to narrowing of the optic canal, which can be appreciated on a multi-slice CT scan with a bone window. In this case, decompression of the optic nerve is an essential step in the surgical procedure.
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Figure 4.2: CT of the orbit to the patient.

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Figure 4.3: Different extension of meningioma in relation to the sphenoid wing.

  • The classic triad of sphenoid (spheno-orbital) wing meningioma includes painless proptosis, visual impairment, and ocular paresis. Headache is also a common manifestation, and patients may sometimes experience ptosis. Additionally, patients may present with retro-orbital pain or a sensation of pressure.