Medial sphenoid wing parasellar meningioma masquerading as temporomandibular joint disorder: A case report

Abstract

Orofacial pain may be multifactorial. Intracranial pathologic conditions can result in symptoms mimicking temporomandibular disorders (TMD) and orofacial pain (OFP). Meningioma is a common benign intracranial tumor. 1 American Association of Neurological SurgeonsNeurosurgical conditions and treatments. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Meningioma Google Scholar Approximately 11% through 20% of all meningiomas originate from the arachnoid cap cells and are attached to the meninges along the wing of the sphenoid bone, and approximately one-half arise from the medial aspect. 2 Cohen-Gadol A. Medial sphenoid wing meningioma:principles of resection. The neurosurgical atlas. https://www.neurosurgicalatlas.com/volumes/cranial-base-surgery/skull-base-meningioma/medial-sphenoid-wing-meningioma Google Scholar Sphenoid ridge meningiomas constitute approximately 20% of supratentorial meningiomas. 3 Basso A. Carrizo A.G. Duma C. Sphenoid ridge meningiomas. in: Roberts D.W. Schmidek H.H. Operative Neurosurgical Techniques: Indications, Methods, and Results 4th ed. W.B. Saunders, Philadelphia2000: 316-324 Google Scholar Meningiomas are most prevalent in patients aged 30 through 70 years. 1 American Association of Neurological SurgeonsNeurosurgical conditions and treatments. https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Meningioma Google Scholar Although most meningiomas are benign, they have a tendency to slowly increase in size. When enlarged, depending on their location, they can be severely disabling or life-threatening. 4 American Association of Neurological Surgeons. Meningiomas. Available at: https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Meningiomas. Accessed January 30, 2019. Google Scholar Because most meningiomas slowly increase in size, symptoms develop gradually. Common clinical initial symptoms include blurred vision, numbness, headaches, weakness of the arms or legs, and seizures. 5 al-Mefty O. Ayoubi S. Clinoidal meningiomas. Acta Neurochir Suppl (Wien). 1991; 53: 92-97 Crossref PubMed Scopus (46) Google Scholar If symptoms are suggestive of a tumor, magnetic resonance imaging (MRI), computed tomographic scanning, or both are indicated. 6 Bikmaz K. Mrak R. Al-Mefty O. Management of bone-invasive, hyperostotic sphenoid wing meningiomas. J Neurosurg. 2007; 107: 905-912 Crossref PubMed Scopus (95) Google Scholar ,7 Maroon J.C. Kennerdell J.S. Vidovich D.V. Abla A. Sternau L. Recurrent spheno-orbital meningioma. J Neurosurg. 1994; 80: 202-208 Crossref PubMed Scopus (125) Google Scholar These studies can aid in locating the meningioma and determining its size. On occasion, a biopsy may be performed. 8 WebMD Meningioma. https://www.webmd.com/cancer/brain-cancer/meningioma-causes-symptoms-treatment#1 Google Scholar The tumor must be removed in part, or in some cases totally excised, to determine if it is benign or malignant. Radiation therapy can be used to treat malignant tumors 9 Malik I. Rowe J.G. Walton L. Radatz M.W. Kemeny A.A. The use of stereotactic radiosurgery in the management of meningiomas. Br J Neurosurg. 2005; 19: 13-20 Crossref PubMed Scopus (66) Google Scholar when directed at areas inaccessible to the surgeon. Surgical management of medial sphenoid wing meningiomas (SWMs) is challenging owing to the closely associated critical neurovascular structures along the parasellar region. 10 Puzzilli F. Ruggeri A. Mastronardi L. Agrillo A. Ferrante L. Anterior clinoidal meningiomas: report of a series of 33 patients operated on through the pterional approach. Neuro Oncol. 1999; 1: 188-195 Crossref Scopus (45) Google Scholar SWMs are associated with higher morbidity, mortality, and recurrence rates than meningioma in other locations. 5 al-Mefty O. Ayoubi S. Clinoidal meningiomas. Acta Neurochir Suppl (Wien). 1991; 53: 92-97 Crossref PubMed Scopus (46) Google Scholar ,11 Dufour H. Muracciole X. Métellus P. Régis J. Chinot O. Grisoli F. Long-term tumor control and functional outcome in patients with cavernous sinus meningiomas treated by radiotherapy with or without previous surgery: is there an alternative to aggressive tumor removal?. Neurosurgery. 2001; 48: 285-294 PubMed Google Scholar ,12 Al-Mefty O. Clinoidal meningiomas. J Neurosurg. 1990; 73: 840-849 Crossref PubMed Scopus (155) Google Scholar The rate of recurrence is one of the highest among all intracranial meningiomas. 13 Mathiesen T. Lindquist C. Kihlström L. Karlsson B. Recurrence of cranial base meningiomas. Neurosurgery. 1996; 39: 2-7 Crossref PubMed Scopus (267) Google Scholar Dr. Kalladka is an adjunct assistant professor, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY 14620. Dr. Al Obaidi is a resident, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY. Dr. Babu is a consultant, Oral and Maxillofacial Surgery. Columbia Asia Hospital, Bengaluru, Karnataka, India. Dr. Maloth is an associate professor, Department of Dentistry, Koppal Institute of Medical Sciences, Koppal, Karnataka, India. Dr. Khan is an associate professor and program director, Orofacial Pain and Temporomandibular Disorders, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY.