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Table of Contents    
Year : 2017  |  Volume : 65  |  Issue : 3  |  Page : 677-679

Bilateral mirror image sphenoid wing meningiomas

Department of Neurosurgery, Seth G.S. Medical College and K.E.M. Hospital, Parel, Mumbai, Maharashtra, India

Date of Web Publication9-May-2017

Correspondence Address:
Manoj Patil
Department of Neurosurgery, Second Floor, K.E.M. Hospital, Parel, Mumbai - 400 012, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/neuroindia.NI_204_16

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How to cite this article:
Patil M, Mahore A, Sathe P, Chagla A. Bilateral mirror image sphenoid wing meningiomas. Neurol India 2017;65:677-9

How to cite this URL:
Patil M, Mahore A, Sathe P, Chagla A. Bilateral mirror image sphenoid wing meningiomas. Neurol India [serial online] 2017 [cited 2019 Dec 15];65:677-9. Available from:

A 64-year old female patient presented with headache and telegraphic speech for 2 months. On examination, she had motor dysphasia and bilateral papilledema. Contrast-enhanced magnetic resonance imaging (MRI) revealed dural-based, extra-axial, intensely enhancing masses involving the sphenoid wings on either side with mass effect. The size of the tumor and mass effect were more on the left side [Figure 1]a,[Figure 1]b,[Figure 1]c,[Figure 1]d,[Figure 1]e. The patient was planned for staged resection of the tumors, first on the left side. She underwent a left frontotemporal craniotomy with maximal safe resection of the left-sided tumor safeguarding the major vessels. She had improvement in headache and dysphasia in the postoperative period. The histopathological picture was consistent with transitional meningioma [Figure 1]f. She is neurologically stable at the end of 1 year; however, the patient and her family are unwilling for operation on the right side. Mirror meningiomas are well-known at falx, orbit, and parasagittal locations [Table 1]. However, greater wing of the sphenoid as a location for mirror meningiomas remains undescribed in literature. Radiologically, these are similar to isolated meningiomas. The incidence of multiple intracranial meningiomas is reported to be between 5.4 and 8.9%. Most of these are located in a hemicranial distribution. Sphenoid wing meningiomas constitute 20% of intracranial meningiomas.[1],[2] Multiple meningiomas can occur in the setting of neurofibromatosis (NF-1 and NF-2), meningiomatosis, meningioangiomatosis, or sporadically. Our patient did not have other markers for NF confirming its sporadic nature. Multiple meningiomas can arise independently, as confirmed by the histological and cytogenetic differences between multiple tumors from the same patient; or, from the spread of original clone of cells throughout the meninges after a single transforming event, resulting in the genesis of multiple, clonally-related tumors.[2],[3],[4] Operative management of bilateral meningiomas poses special problems. A decision is made regarding which lesion needs to be addressed initially. Masterly inactivity with serial imaging is needed for small, asymptomatic tumors. The majority of multiple meningiomas (80–90%) are circumscribed, slowly growing, have a good postsurgical prognosis, and are classified as World Health Organization (WHO) grade 1.[2] On the contrary, meningiomas in younger patients tend to have an aggressive behavior and an unfavorable prognosis. Although meningiomas are one of the most common tumors encountered in neurosurgical practice,[5],[6] multiple meningiomas still remain a rare entity.[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26] Regardless of the final management, such patients require a close, periodic, and prolonged follow-up.
Figure 1: Post-contrast axial views (a-c) and post-contrast coronal view (d) of MRI showing the dural-based, extra-axial, intensely enhancing, bilateral sphenoid wing lesions with a midline shift towards the right. T2W axial image showing isointense lesions with encasement of arteries of anterior circle of Willis and peritumoral edema on the left side (e). Photomicrograph showing meningothelial cells arranged in a syncytial and whorling pattern, suggestive of transitional meningioma (H and E 40×) with psammoma bodies (inset) (f)

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Table 1: List of individual cases of mirror meningiomas reported in literature

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  References Top

Bhatoe HS. Simultaneous occurrence of multiple meningiomas in different neuraxial compartments. Neurol India 2003;51:263-5.  Back to cited text no. 1
[PUBMED]  [Full text]  
Domenicucci M, Santoro A, D'Osvaldo DH, Delfini R, Cantore GP, Guidetti B. Multiple intracranial meningiomas. J Neurosurg 1989;70:41-4.  Back to cited text no. 2
Whittle IR, Smith C, Navoo P, Colile D. Meningiomas seminar. Lancet 2000;363:1535-43.  Back to cited text no. 3
Jain SK, Sundar IV, Sharma V, Goel RS, Prasanna KL. Multiple spinal and cranial meningiomas: A case report and review of literature. Asian J Neurosurg 2015;10:132-4.  Back to cited text no. 4
[PUBMED]  [Full text]  
Verma SK, Sinha S, Sawarkar DP, Singh PK, Gupta D, Agarwal D, et al. Medial sphenoid wing meningiomas: Experience with microsurgical resection over 5 years and review of literature. Neurol India 2016;64:464-74.  Back to cited text no. 5
Sankhla S. Medial sphenoid wing meningioma. Neurol India 2016;64:476-7.  Back to cited text no. 6
[PUBMED]  [Full text]  
Konar S, Bir SC, Maiti TK, Kalakoti P, Nanda A. mirror meningioma at foramen magnum: A management challenge. World Neurosurg 2016;85:364.  Back to cited text no. 7
Franceschetti A, Babel J, Werner A. Double primary tumor: Bilateral meningioma of the falx appearing 25 years after a pigmented tumor of the optic papilla. Rev Otoneuroophtalmol 1967;39:333-4.  Back to cited text no. 8
Ausman, JI. Strategy and technique for removal of a falcine.meningioma in a patient presenting with bilateral meningiomas. Surg Neurol 2001;55:204-8.  Back to cited text no. 9
Kaplan A. Bilateral parasagittal meningioma with resection of the anterior third of the superior longitudinal sinus. J Mt Sinai Hosp NY 1949;15:313-9.  Back to cited text no. 10
Browder J, Kaplan H. Venous shunts in bilateral parasagittal meningioma. Trans Meet Am Surg Assoc Am Surg Assoc 1950;68:96-106.  Back to cited text no. 11
Sarkar H, Ghosh S. Bilateral “mirror” cystic meningiomas: A rare radiological presentation. Neurol India 2011;59:309-10.  Back to cited text no. 12
[PUBMED]  [Full text]  
Nakano M, Tanaka T, Nakamura A, Watanabe M, Kato N, Arai T, et al. Multiple pulmonary metastases following total removal of a bilateral parasagittal meningioma with complete occlusion of the superior sagittal sinus: Report of a case. Case Reports in Neurological Medicine, vol. 2012, Article ID 121470, 7 pages, 2012. doi: 10.1155/2012/121470. Last accessed 30.3.2017.  Back to cited text no. 13
Sood GC, Malik SK, Gupta DK, Gupta AN. Bilateral meningiomas of the orbit. Am J Ophthalmol 1966; 61:1533-5.  Back to cited text no. 14
Salazar JL, Bauer J, Frenkel M, Sugar O. Bilateral optic canal meningioma. Surg Neurol 1977;8:11-4.  Back to cited text no. 15
Trobe JD, Glaser JS, Post JD, Page LK. Bilateral optic canal meningiomas: A case report. Neurosurgery 1978;3:68-74.  Back to cited text no. 16
Liaño H, García-Alix C, Lousa M, Marquez M, Nombela L, de Miguel J. Bilateral optic nerve meningioma. Case report. Eur Neurol 1982;21:102-6.  Back to cited text no. 17
Rossazza C, Larmande A, Tarle P. Bilateral meningioma of the optic nerve sheath. Bull Soc Ophtalmol Fr. 1986;86:1527-9.   Back to cited text no. 18
Camuzet F, Hadad M, De Chastaigner V, Bec P. Bilateral meningioma of the optic nerve. Bull Soc Ophtalmol Fr 1987; 87; 39-42. 1 1987.   Back to cited text no. 19
Benichou C, Sahel J, Maitrot D, Heldt N, Kelner C, Bronner A. Bilateral meningioma of the optic nerve. Discussion apropos of a case. J Fr Ophtalmol 1987;10:783-7.  Back to cited text no. 20
Cunliffe IA, Moffat DA, Hardy DG, Moore AT. Bilateral optic nerve sheath meningiomas in a patient with neurofibromatosis type 2. Br J Ophthalmol 1992; 76: 310-2.  Back to cited text no. 21
Nair A, Behari S, Jain M, Jaiswal AK. Bilateral primary optic nerve sheath meningiomas with pneumosinus dilatans. Acta Neurochir (Wien) 2011;153:2495-7.  Back to cited text no. 22
Kothari NA, Kulkarni KM, Lam BL. Untreated bilateral optic nerve sheath meningiomas observed for 27 years. J Neuroophthalmol 2013;33:45-7.  Back to cited text no. 23
Nickel M, Löbel U, Holst B, Kammler G, Matschke J, Schulz A, et al. Unexplained loss of vision in a child: Consider bilateral primary optic nerve sheath meningioma. Neuropediatrics 2014;45:321-4.  Back to cited text no. 24
Misra S, Misra N, Gogri P, Mehta R. A rare case of bilateral optic nerve sheath meningioma. Indian J Ophthalmol 2014;62:728-30.  Back to cited text no. 25
[PUBMED]  [Full text]  
Luetjens G, Krauss JK, Brandis A, Nakamura M. Bilateral sphenoorbital hyperostotic meningiomas with proptosis and visual impairment: A therapeutic challenge. Report of three patients and review of the literature. Clin Neurol Neurosurg 2011;113:859-63.  Back to cited text no. 26


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