Wing Meningiomas | ANS Brain Tumor Center NJ
  • Metastatic Brain Tumor

    Olfactory Groove and Sphenoid Wing Meningiomas

    Meningiomas are typically benign, slow-growing tumors that arise from the meninges. The meninges are a protective membrane surrounding the brain and spinal cord. These tumors do not arise from the brain itself but instead grow inward from the meninges displacing the brain or spinal cord. Although most meningiomas are benign slow growing tumors, higher-grade (Atypical and Malignant) meningiomas can occur in a small minority of patients. Meningiomas, in general, are relatively common tumors, making up about 30% percent of all primary brain tumors, and can occur anywhere on the meninges. The tumors can occur in anyone, but they appear to be most common in middle-aged women.

    It is common to name meningiomas based on the location of the tumor in relation to the overlying skull. Olfactory groove meningiomas grow next to the nerves that run between the brain and the nose, the nerves that allow you to smell. They can become large without causing significant neurologic deficits or evidence of increased intracranial pressure. Loss of smell can often be the only symptom. Other neurological symptoms are often uncommon until the tumor has reached a large size.

    Meningiomas of the sphenoid wing form on the skull just behind the eyes and are traditionally divided into three types: lateral, middle, and medial (clinoidal). Lateral sphenoid wing meningiomas involve the sphenoid ridge and the surrounding frontal and temporal lobes. Medial sphenoid ridge (clinoidal) meningiomas, often compress the optic nerve and can involve the carotid artery and cavernous sinus to cause double vision and numbness of the face.


  • Symptoms

    Meningiomas are usually slow growing and, therefore, may grow to a large size before causing symptoms.  The symptoms of a meningioma are caused by the pressure the growing tumor exerts on surrounding brain or nerves. Depending on the location of the mass, meningiomas may cause headaches, seizures, weakness or numbness in the limbs or face, visual problems, and gradual changes in mood or personality. The symptoms tend to increase in severity as the tumor grows in size.

    Olfactory groove meningiomas often lead to the loss of the sense of smell. If they grow large enough, they can also compress the optic nerves to the eyes and surrounding brain, causing visual symptoms, headaches, seizures and personality changes. Sphenoid wing meningiomas can cause visual problems, including loss of peripheral vision and even unilateral mon-occular blindness. In addition, they can cause facial numbness, double vision, headaches and seizures.


    Diagnosis These tumors are diagnosed with a neurological examination followed by imaging studies of the brain, usually a computed tomography (CT) or magnetic resonance imaging (MRI) scan. The scan is usually performed with a contrast dye that makes the border and details of the tumor more visible in relation to the surrounding normal brain. The scan also provides detail information regarding the exact size, location and other structures involved by the tumor. An angiogram, which allows physicians to visualize the blood vessels in the area, may also be used for emobolization of a very vascular tumor and closing off its blood supply. Only examination of a patient’s tumor tissue under a microscope can confirm an exact diagnosis. This tissue is usually obtained with tumor resection.


    Treatment

    If a particular meningioma is small and does not cause any symptoms, it may be observed over time rather than treated immediately. In this situation surveillance MRI scans will be recommended to monitor the stability of the tumor over time. In cases in which treatment is necessary, surgery is usually the primary form of treatment for a meningioma. Because most meningiomas are benign, and rarely invade the surrounding brain tissue, complete resection often results in a cure.

    With contemporary microsurgical and skull base techniques, many of these tumors now can be removed. Prior to surgery, some patients can benefit from embolization of the blood supply to a meningioma which can make complete removal easier for the surgeon. Usually surgery is performed with a frameless stereotactic navigation system in which a high-resolution MRI is used to construct a three-dimensional brain model that allows for minimally invasive surgery. While every effort is aimed at total removal, certain tumors present a formidable technical challenge because they adhere to vital neural and vascular structures at the base of the brain. After surgery, the tumor tissue is microscopically examined to establish an accurate diagnosis, assess the risk of recurrence and dictate the next step in treatment.

    Conventional external beam radiation therapy may be used as a follow-up treatment, especially for malignant or atypical tumors that have recurred. In addition, non-invasive, stereotactic radiosurgery (CyberKnife and Gamma Knife) may be used as either primary or adjunct treatment for small or residual tumors in difficult to reach locations or in patients that cannot undergo surgery. Stereotactic Radiosurgery uses numerous finely focused beams of radiation to accurately target the tumor and while minimizing the effects to any surrounding tissue. The target tumor is usually outlined on a 3-Dimensional model of the brain by the neurosurgeon and the radiation oncologist prior to the procedure.

    After surgery, each patient is reviewed at our Multi-Disciplinary Tumor Board with an expert team of neuro-oncologists, medical oncologists, neuro-pathologists, neuro-radiologists and neurosurgeons. Together the tumor board recommends the best treatment options for each patient, incorporating ongoing national clinical trials and the latest treatment protocols.


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Directors of the ANS Brain Tumor Center