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NEUROIMAGES
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
India
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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: http://www.neurologyindia.com/text.asp?2017/65/3/677/205905


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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