Sphenoid Wing Meningioma

Contributor:

Dr. Chris Ekong

Consultants:

Dr. Michael Schwartz
Dr. Fred Gentili
Dr. May Tsao
Dr. Renn Holness

Case 11

Age: 72

Sex: Male

History: May 2001 - One grand mal seizure in may 2001. Neurosurgically intact.

Treatment:

1. observe

To Dr. F. Gentili, Dr. M. Schwartz, Dr. M. Tsao and Dr. Renn Holness - September 4, 2001

Dear Mike, May, Fred and Renn:

This 72 year old healthy man presented with one episode of grand mal seizure. The seizure is well controlled with dilantin. CT and MRI of the brain are suggstive of a small spenoid wing meningioma. I have recommended observation and repeat MRi in one year. He is interested in looking at other options such as surgery or stereotaxic radiation. Your opinion would be greatly appreciated.

Regards,

Chris

Dr. F. Gentili, Neurosurgeon, Toronto

Dear Chris:

Thank you for giving me the opportunity to comment on this patient. The MRI suggest a medial sphenoid wing/lateral cavernouis sinus meningioma. It is interesting that he has presented with a grand mal seizure. I wonder if the T2 weighted MRI shows edema in the surrounding brain. Your treatment option of observation with repaet MRI is quite reasonable. I think however that this lesion is totally resectable with relatively low morbidity. If the the patient is medically fit and especially if the T2 weighted scan show edema I would offer him the choice of surgery. I do not feel that stereotactic radiosurgery is indicated. I would be happy to discuss him with you further.

Best regards,

Fred

Dr. Renn Holness, Neurosurgeon, Halifax

Dear Chris:

This can be readily treated by either method but in view of age and the critical site at the cav sinus & proximal Sylvian fissure I would observe but scan > frequently (q 6 monthly).If the lesion enlarges then Rx will be needed before which a better look at the major vessels would be desirable (MRA).

Regards,

Renn

Dr. Chris Ekong, Neurosurgeon, Regina

We have now received consultation reports from our Neuro Internet Rounds consultants in Toronto, Halifax and Regina. Everybody has agreed that observation of the lesion with follow-up MRI is quite reasonable. One surgeon felt that the lesion was totally resectable with low morbidity if the patient is medically fit. A couple of the surgeons felt that surgery was an acceptable option but because of the patient’s age and the tumour being on the dominant side of the brain and somewhat close to the cavernous sinus they felt more comfortable leaving it alone unless follow-up MRI showed a definite increase in size. A couple of the surgeons felt that the follow-up MRI should be done more frequently (ie. every six months) rather than yearly. I will pass these comments to the patient and arrange to review him clinically and repeat his MRI in six months.

Thank you. Yours sincerely,

Chris

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