CAZ PARTICULAR DE MENINGIOM DE ARIPA DE SPHENOID

Abstract

Meningiomas, so named by Harvey Cushing in 1922, are tumors that arise from arachnoidal cells of the meninges. Meningiomas constitute about 15% of cerebral tumors and 25% of spinal cord tumors. Since most meningiomas are benign and completely respectable, only 6% of brain tumors causing death are meningiomas. [PUBLICATION ABSTRACT]

Rodica MARINESCU

Spitalul clinic de urgenti Galati

Viorica LEFTER

Medic primar BTF "LACU SARAT"

Magdalena MOROÇANU, Paul ICHIM

Spitalul Clinic de Urgenti Galat

Cuvinte cheie: spital, caz, aripa de sphenoid

Rezumat

Meningioamele, numite asa de catre Harvey Cushing in 1922, sunt tumori dezvoltate din celulele arahnoidiene ale meningelui.

Eie reprezinta 15% din tumorile cerebrale si 25% din tumorile medulare.

Deoarece majoritatea meningioamelor sunt benigne si complet rezecabile, numai 6% dintre tumorile cerebrale care due la deces, sunt meningioame.

Apar la adulti cu varste cuprinse intre 20 si 60 de ani, incidenta maxima fiind in jurul varstei de 40 de ani, mai freevent la femei.

Sunt leziuni solitare, dar in 1% din cazuri apar meningioame multiple, singure sau associate cu neurofibromatoza.

In prezenta lucrare, autorii prezinta un caz particular de meningiom de aripa de sphenoid, in care examenul tomografie urmat de reconstructie 3D a permis evaluarea extinderii tumorii si a leziunilor osoase.

Aspecte Generale

In etiologia meningioamelor sunt indicate ca factori agravanti, inflamatiile cronice, iradiatiile terapeutice sau de diagnoza, traumatismele si sarcina

Majoritatea meningioamelor se dezvolta bine delimitai, rotunde sau ovale, omogene si atasate de dura. Eie compreseaza dar nu invadeaza creierul si sunt asocíate cu modificali osoase.

Cele maligne invadeaza tesuturile invecinate (dura, oasele adiacente, arterele cerebrale, nervii cranieni, sinusurile venoase).

Metastazeaza in plamani, ficat, ganglionii limfatici si oase.

Evolutia clinica depinde de localizare si de dimensiunile tumorii.

Investigatie cu Computerul Tomograf

Computerul tomograf a devenit cel mai important test de diagnoza a meningiomului deoarece pe langa identificarea tumorii ne permite sa estimam si alterarea anatomica a tesuturilor, calcificarea peritumorala, edemul, si modificarile osoase.

Reconstructia 3D permite o mai buna estimare a tuturor modificarilor aparute ajutand foarte mult neurochirurgul. Deci, permite o evaluare mult mai exacta a conexiunilor cu structurile adiacente.

Pe imaginea de tomograf meningioamele apar structuri spontane hiperdense (40-80 UH), cu afinitate crescuta la iod datorata vascularizatiei abundente si edemului peritumoral. Imaginile date de computerul tomograf cu sauf ara substanta de contrast au o acuratete de 96% pentru meningioame.

Meningioamele de aripa de sphenoid

Pot fi impartite in trei categorii : mijlocii, mediale si externe

In continuare ne vom ocupa de un meningiom extern

Meningioamele externe sunt hiper ostozante si caracteristicile lor clinice sunt:

- Exoftalmie unilateral, ireductibilitate, progress lent, nepulsatile, ochiul se misca in jos fata de axa orizontala;

- Miscarile globului ocular sunt reduse datorita discomfortului;

- Cefalee, staza papilara

- Crize epileptice

Mai jos este prezentat cazul unei femei de 54 de ani din Galati, internata cu exoftalmie dreapta, crize epileptice si deficit motor stang.

Tomograful a evidentiat o structura tumorala de dimensiuni mari, intens iodofila, dezvoltata in fosa dreapta in contact cu aripa sfenoidului. Structura a invadat orbita cauzand exoftalmia, (vezi imaginea 1)

Recontructia 3D a relevat impotante distrugeri osoase la nivelul temporal al orbitei si la nivelul peretelul lateral al acesteia.(vezi imaginea 2)

chirurgical s-a observat ca structira tumorala s-a dezvoltat preponderent extradural si a fot complet extrasa.(vezi imaginea3)

Examenul histopatologic a relevat un meningiom malign.

Concluzii

Investigatine CT urmate de recontructia 3D sunt foarte utile in orientarea tratamentului chirurgical si in identificarea meningioamelor. In cazul de fata :

- Avem districtii osoase, procesul tomoral este preponderent extradural si are dimensiuni uriase ;

- lunand in calcul cresterea lenta a presupunem ca a fosst initial benigna;

- investigarea in faza initiala de evolutie a meningiomului ar fi fost in beneficiai pacientului.

Bibliografie

1. Donaldson, AJames-Surgical anatomy of the temporal bone- RAVEN PRESS, New York, 1992;

2. Samii, M.- Atlas of cranial base surgery- Saunders, Philadelphia, 1998,

3. Pettersson, H.- The Encyclopaedia of Medical Imaging -The NICER Instiute, 2000;

4. Wilkins, R.H; Rengachary,S.S.- Neurosurgery-Mc Graw-Hill Book Company, 1993

PARTICULAR CASE OF A SPHENOID WING MENINGIOMA

Rodica MARINESCU

"The County Hospital Galati"

Viorica LEFTER

primary medicine BFT "Lacu Sarat"

Magdalena MOROSANU, Paul ICHIM

"The County Hospital Galati"

Keywords: case particular, sphenoid wing meningioma

Abstract

Meningiomas, so named by Harvey Cushing in 1922, are tumors that arise from arachnoidal cells of the meninges.

Meningiomas constitute about 15% of cerebral tumors and 25% of spinal cord tumors.

Since most meningiomas are benign and completely respectable, only 6% of brain tumors causing death are meningiomas.

They are tumors of adults with the age ranging between 20 and 60, the peak incidence being around the age of 40, more common in women.

Meningiomas are solitary tubers, but less than 1% are multiple occurring alone or in association with neurofibromatosis.

In this paper the authors deal with a particular case of sphenoid wing meningioma where the CT investigation followed by 3D reconstruction allowed the spreading tumor and bony lesions estimation.

General Aspects

In meningiomas etiology were involved chronic inflammations, therapeutics or diagnose irradiation, traumatisms and pregnancy as aggravating agent.

Most meningiomas are benign, well circumscribed, round or oval, homogeneous and attached to the dura. They compess but do not invade the brain and are associated with bone changes.

The maligne ones invade surrounding tissues ( dura, adjacent bone, extracranial musculature, cerebral arteries, cranial nerves and venous sinuses).

Metastasis are in lung, liver, limph nodes and bones.

The clinical features depend on the location and extension of the tumor.

Computed Tomography Investigation

CT has become the most important test in the diagnosis of meningioma because in addition to identifying the tumor, it allows the estimation of anatomical alteration, calcification peritumoral oedema and bone changes. The 3D reconstruction allows a better estimation of all these changes being a helping hand for the neurosurgeon. Thus, there is a more accurate evaluation of connections with the adjacent structures.

On the CT image meningiomas appear as spontaneous hyperdense structures (40-80 UH), intense iodophil due to the abundant vascularization, with peritumoral oedema.

CT with and without contrast is reported to be positive in 96% of meningiomas and specific for diagnosis in 90%.

Sphenoid wing meningiomas

Can be divided into trhee general categories: middle, medial and external meningiomas.

Further we'll deal with those of the external third.

The external meningiomas are hyperostosing and their clinical features are:

- unilateral exophthalmia, irreductible, slowly progressive, impulsatile, the eye moved down as against the horizontal axis;

- the ocular globe motions are reduced owing to the mechanical discomfort;

- chephalea, papillary stasis;

- temporal crises.

Further down we present the case of a 54 years woman from Galati, hospitalized with right exophthalmia, temporal crises and left motor deficit.

CT scan emphasized a big size tumoral structure, intense iodophil, developed in the right fossa in contact with the sphenoid wing. The structure invaded the orbit causing exophthalmia. The 3D reconstruction proved important bony destructions at the level of the temporal scale of orbit floor and lateral wall.

Surgically had been found that the structure was developed prevailing extradural and was completely removed.

The anatomico-pathologic diagnosis was malignant meningioma.

Conclusions

Computed tomography investigation followed by 3D reconstruction is very useful for the lesion extension accurate estimation with the view of surgical manner choise;

- the presented case feature consists in the bone distruction changes, the tumoral process prevalent extradural evolution and its giant size;

- taking into account size and the slow rate of tumor increase it is supposed to be initially benign;

- the investigation in the initial phases of meningioma evolution would have been for the benefit of the patient.