Sphenoid Ridge Research Articles

Spheno-Orbital Meningioma and Vision Impairment—Case Report and Review of the Literature

(1) Background: Spheno-orbital meningioma (SOM) is a very rare subtype of meningioma which arises from the sphenoid ridge with an orbital extension. It exhibits intraosseous tumor growth with hyperostosis and a widespread soft-tissue growth at the dura. The intra-orbital invasion results in painless proptosis and slowly progressing visual impairment. (2) Methods: We present a case of a 46-year-old woman with SOM and compressive optic nerve neuropathy related to it. Her corrected distance visual acuity (CDVA) was decreased to 20/100, she had extensive visual field (VF) scotoma, dyschromatopsia, impaired pattern-reversal visual-evoked potential (PVEP), and decreased thicknesses of the retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC), measured with the swept-source optical coherence tomography (SS-OCT), and a pale optic nerve disc in her left eye. Brain CT and MRI showed a lesion at the base of the anterior cranial fossa, involving the sphenoid wing and orbit. Pterional craniotomy and a partial removal of the tumor at the base of the skull and in the left orbit with the resection of the lesional dura mater and bony defect reconstruction were performed. (3) Results: The histological examination revealed meningothelial meningioma (WHO G1). Decreased CDVA and VF defects completely recovered, and the color vision score and PVEP improved following the surgery, but RNFL and GCC remained impaired. No tumor recurrence was observed at a follow-up of 78 months. (4) Conclusions: Optic nerve dysfunction has the capacity to improve once the compression has been relieved despite the presence of the structural features of optic nerve atrophy.

Surgical management of bony orbit tumors

BackgroundA variety of primary tumors affect the bony orbit. They include, sphenoid ridge meningioma, fibrous dysplasia, ossifying fibroma, osteoma and aneurismal bone cyst. Controversies in the treatment strategies still exist. This study is retrospective study that included 20 patients operated upon in the last three years—at neurosurgery department in Minia University Hospital—with tumors related to the bony orbit. We studied the data, to see what was done, what should have been done. CT and MRI were used for all patients preoperatively and for postoperative follow-up.ResultsFourteen patients had sphenoid ridge meningiomas, two patients had osteomas, two patients had fibrous dysplasia, one had ossifying fibromas and one aneurysmal bone cyst. Proptosis improved in all cases. But one patient had deterioration of vision. There were no postoperative cases of enophthalmos or pulsating exophthalmos.ConclusionsEarly surgical intervention is mandatory before the tumor becomes less amenable. Both CT and MRI should be done preoperatively. Opening the bony superior orbital fissure is a mandatory step in all cases, whereas the optic canal should be drilled out open only if the optic nerve is compromised within the canal. Thorough knowledge of the skull base operative techniques is a must.

Modified lateral orbitotomy approach for resection of anterior temporal cavernous malformation

Background: The lateral orbitotomy approach (LOA) provides a direct and minimally invasive corridor to orbital apex, cavernous sinus, and middle cranial fossa (MCF) lesions. Removal of the lateral orbital wall and retraction of the orbital contents, as performed with a traditional LOA, can cause diplopia and enophthalmos and affect visual acuity. The modified LOA (mLOA) preserves the lateral orbital wall to limit this morbidity.Case Description: A 58-year-old man experienced new-onset headaches and anxiety attacks that improved with anti-seizure medication. He was neurologically intact on examination. Magnetic resonance imaging demonstrated a 2-cm right anterior temporal cavernous malformation with an associated hemosiderin ring. Electroencephalogram revealed right temporal intermittent rhythmic delta activity suspicious for anterior temporal lobe epilepsy. He underwent an endoscopic-assisted keyhole mLOA for resection of the cavernoma and hemosiderin-stained brain. Key steps included a Y-shaped incision in the upper eyelid/lateral canthus, removal of a 1.5-cm segment of the lateral orbital rim, drilling of the lateral orbital wall with preservation of the medial cortex, drilling the lateral sphenoid ridge to access the anterior temporal lobe, resecting the cavernoma with endoscopic assistance for removal of all potentially epileptogenic abnormal brain, and plating the orbital rim as part of a layered closure. Postoperatively, he remained neurologically intact. He was discharged on postoperative day 4 after resolution of a cerebrospinal fluid leak with lumbar drainage. On follow-up, his anxiety attacks had completely resolved, and his incision was well-healed.Conclusion: The mLOA is an ideal keyhole technique for selected lesions of the MCF.

Small Sphenoid Ridge as a Factor Associated with Laterally Deviated Proximal Sylvian Fissure in Patients Undergoing Pterional Craniotomy

During the pterional-transsylvian approach, we sometimes encounter the proximal Sylvian fissure (SF) deviating laterally beyond the fold of the sphenoidal ridge (SR) and experience difficulty dissecting the SF due to the deep and oblique dissection plane. In the present study, we explored the association between the height of the SR and lateral deviation of the SF during the pterional-transsylvian approach. The association between the height of the SR on axial computed tomography and the presence of a laterally deviated SF was evaluated by reviewing patients who had undergone pterional craniotomy. Among the 52 patients included, lateral deviation of the SF was observed in 8 patients (13.4%). The median height of the SR was significantly smaller in patients with laterally deviated SF (6.0mm) than in patients with non-deviating SF (13.4mm; P<0.0001). The oculomotor nerves and middle fossa were observed at the edge of the dissection plane of the SF in all patients with a laterally deviating SF, while medial structures such as the internal carotid artery or optic nerve were observed in patients with non-deviating SF. Small SR was associated with lateral deviation of the proximal SF.

One-Piece Frontoorbital Osteotomy With a Small Supraorbital Burr-Hole to Protect Against Intraoperative Dural Lacerations.

This paper aims to describe a new technique of 1-piece frontoorbital osteotomy with a small supraorbital burr hole, which resulted in improved safety during osteotomy of the anterior skull base. An 11 × 4 mm burr hole was created at the center of the orbit above the superior orbital rim using an "eyebrow key-window approach." Extradural dissection from the nasion to the medial side of the sphenoid ridge was performed through this hole, and dissection of the lateral side of the sphenoid ridge was completed from the edge of the coronal osteotomy. Osteotomy along the zygomaticofrontal and sphenofrontal sutures were performed using an oscillating saw with secure protection of the dura. Between December 2019 and June 2020, 3 patients with unilateral coronal craniosynostosis underwent 1-piece frontoorbital advancement with the eyebrow key-window approach. The median age was 11 months (8-15 months), median operation time was 249 minutes (244-255 minutes), and the average blood transfusion was 10.8 ml/kg (0-18 ml/kg). No complications were observed, and the technique was associated with improved safety of osteotomy around the anterior skull base for 1-piece frontoorbital advancement.

Experience of Brain Tumors in Tertiary Care Hospital

Background: Brain tumors arising in the brain are called primary brain tumors. The brain tumors could be meninges, glands, nerves or brain tissue. Although brain tumors comprise of a small number of all cancers, but are disproportionately responsible for cancer-related deaths. The neoplasms may be low grade, high grade, primary tumor or metastatic. Aim: To evaluate the experience of brain tumors in a tertiary care hospital. Place and duration of study: Department of Neurosurgery, CMH, Lahore from March 2021 to March 2022. Methodology: This descriptive study included 38 patients. Age of patients ranged between 26 to 70 years and both genders having primary and secondary (metastatic) brain tumors who were considered fit for surgery were included. Patients who were unfit for anesthesia or unwilling for operation were excluded. Diagnosis of brain tumors was made by histopathology. Results: Mean age was 46.18±12.17 years. Male patients were 25(65.8%) and 13(34.2%) were female. All patients 38(100%) had headache 31(82%) patient had seizures, focal weakness in 26(68.42%) patients and 3(7.89%) patients had urinary/fecal incontinence. Majority of patients 16(42.11%) had glioblastoma, meningioma in 8(21.05%) patients while 3(7.89%) patients had pituitary adenoma. 15(39.47%) patients had tumor in right frontal lobe, 8(21.05%) patients in left parietal lobe and 4(10.52%) patients had tumor in right parietal lobe. Out of 3 patients, 1(2.63%) had right CP angle tumor, 1(2.63%) had in sphenoid ridge tumor, 1(2.63%) had tumor in Tuberculum Sallea respectively. Conclusion: It is concluded that male population had more brain tumor and glioblastomawas the most common tumor. Keywords: Brain tumors, Headache, Glioblastoma, Meningioma.

Anatomy and Diseases of the Greater Wings of the Sphenoid Bone.

The greater wings of the sphenoid bone (GWS) comprise the components of the sphenoid bone that make up most of the posterior orbital wall and form the anterior and medial parts of the floor of the middle cranial fossa. Many important skull base foramina, which transmit vital neurovascular structures, are present in these paired wings on either side of the central body of the sphenoid bone. A wide variety of diseases can affect the GWS, ranging from benign osseus lesions to malignant primary and secondary bone abnormalities. The complex three-dimensional curved (winged) shape of the GWS and the wide array of pathologic entities that affect this bone can make it challenging for the radiologist to report the imaging findings accurately, especially in relation to the important skull base foramina. The authors describe a systematic approach to understanding the three-dimensional anatomy of the GWS and review important diseases, with the aid of imaging examples. Useful imaging "pearls" that can help in making specific diagnoses are provided throughout the article. ©RSNA, 2022.

Training Model for Brain Tumor Removal (Model TOM Meningioma)

With the development of stereotactic radiotherapy, opportunities to perform craniotomies for brain tumors under a microscope are decreasing, making it difficult to learn surgical techniques in clinical practice. For safety and ethical reasons, it is useful to create a brain tumor training model for hands-on practice. We created a sphenoidal ridge meningioma model with the following parameters: (1) the location of the tumor should be distinguishable using neuronavigation, (2) the feeding artery should allow for confirmation and hemostasis, (3) the tumor and brain should be properly adherent and dissectable, and (4) the tumor can be decompressed and removed using an ultrasonic surgical device. We created the model out of polyvinyl alcohol and produced a mold using a 3-dimensional printer. Thirteen young neurosurgeons used these models, and a questionnaire survey was conducted. It was possible to train neurosurgeons for tumor removal using this model. The results of the questionnaire showed that the model, usefulness of the clinical application, and willingness to participate again were highly rated. This model was created to practice procedures with realty and designed to be visualized by navigation systems, to be removed with ultrasonic surgical instruments, and to be dissected using microinstruments. This model is useful to learn surgical techniques and strategies and to test and develop new surgical equipment. Training using a brain tumor model should be good off-the-job training for young neurosurgeons.

Hyperostotic Invasive Meningioma of the Sphenoid Ridge Surgical Considerations: 2-Dimensional Operative Video.

Hyperostotic invasive sphenoid ridge meningiomas are a distinct and recognized entity.1-4 They are characterized by extensive bone involvement and expansive “en plaque” intradural extension.3,5 The goal of this surgery is improving and preserving the visual function and ocular motility while esthetically correcting and reconstructing the exophthalmos and temporal deformity.4,5 The surgery includes radical removal of the involved bone of the sphenoid ridge, orbital walls, and middle fossa floor, in addition to the “en plaque” dural and periorbital involvement and intradural extension.3,5,6 Early decompression of the optic nerve and orbital elements allows preventing visual function deterioration and yields frequent improvement. Thorough planned reconstruction can be achieved by molding a malleable mesh to the patient's skull before the extensive bone removal. Careful orbital wall reconstruction allows one to achieve a good postoperative cosmesis and prevent enophthalmos.4 We demonstrate the principles of this surgery through 2 cases of 46-year-old and 53-year-old women. The first case demonstrates the importance of middle fossa extensive drilling of involved bone and reconstruction while the second case demonstrates the visual decompression and postoperative improvement. The patients consented to the surgeries and publication of their images.

Morphometry of Sella Turcica, Anterior Clinoid Process and Carotico-clinoid Foramen among North Indian Population: A Cross-sectional Study

Introduction: Sella Turcica (ST), a complex bony landmark located on the body of sphenoid bone. Its lateral bony wall mainly consists of anterior and posterior clinoid processes and optic strut which bear a strong relationship with pituitary fossa. Aim: To estimate various morphometric parameters of ST, Anterior Clinoid Process (ACP) with its anatomical variations, Optic Strut (OS) and Carotico-clinoid Foramen (CCF) among North Indian population group. Materials and Methods: The present cross-sectional anatomical study was conducted on 30 adult dry fully ossified skull and 10 formalin fixed adult cadaveric cranial base present in the Department of Anatomy, SGT University Gurugram, Haryana, India, over a period of one year from January 2021 to December 2021 to evaluate various morphometric parameters such as anteroposterior, transverse diameter and depth of sellar region including ACPs with various bony distances. The range, mean and standard deviation of each parameters were measured by using Statistical Package for the Social Sciences (SPSS) latest version (version 21.0) and Student’s t-test was applied for bilateral comparison. Frequency of morphological variability of CCF was calculated in percentages. Results: Among the 40 samples (both dry skull base and cadaveric skulls) the average dimensions of ST were 10.03±2.40 mm, 13.65±2.09 mm and 5.74±1.92 mm as anteroposterior, transverse and depth, respectively. The length, width and thickness of ACP were 11.22±1.74 mm, 8.04±1.73 mm and 2.27±0.70 mm, respectively. Also the length and width of OS were 3.61±0.78 mm and 3.72±0.47 mm, respectively. Significant difference was observed for distance of ACP to OS. The frequency of CCF was 10 (25%) among the total samples both bilateral and unilateral; out of which 8 (80%) of the samples presented with incomplete foramen, 1 (10%) presented contact type of CCF, and 1 (10%) of the samples exhibited a complete variety of CCF. Conclusion: Bilateral significant difference was observed for the transverse diameter. The mean value for length of ACP was found significant. Detailed morphometry and morphological variations of structures present in sellar region is mandatory for the clinicians specially neurosurgeons and radiologist for the diagnosis and to decide the modality of treatment.

Spheno-orbital Meningiomas: A Case Report

Spheno-orbital meningiomas are benign tumors. They arise intracranially from the sphenoid ridge arachnoid villi cap cells, extending into the orbit. Herein, the authors report a case of a 50-year-old female who presented to Ophthalmology department with a complaint of right eye proptosis. Magnetic resonance imaging and biopsy showed a right sphenoid-orbital meningioma. The tumor was excised and the patient symptomatically improved. Patient had gross tumor reduction for right sphenoidal orbital extra-axial brain tumor with hyperostosis of the lateral wall of the orbit and sphenoidal ridge. Key words: Arachnoid, Brain neoplasms, Exophthalmos, Hyperostosis, Meningioma, Magnetic resonance imaging

Extensive pneumatisation of the sphenoid bone: anatomical investigation of the recesses of the sphenoid sinuses and their clinical importance.

There is a great variance between the extents of pneumatisation of the sphenoid sinuses that can reach beyond the body of the sphenoid bone. The purpose of this study was to find the prevalence of the recesses of the sphenoid sinuses in Polish adult population. Two hundred ninety-six computed tomography (CT) scans of patients who did not present any pathology in the sphenoid sinuses were evaluated in this retrospective analysis. Spiral CT scanner (Siemens Somatom Sensation 16) was used to glean the medical images. Standard scan procedure was applied, with Siemens CARE Dose 4D option enabled. No contrast medium was administered. In the majority of the patients (93.92%), the pneumatisation of the sphenoid sinuses expanded beyond the body of the sphenoid bone; hence, there were recesses of the sinuses present. The most common variant was the presence of two recesses - 12.84% of cases. The prevalence of all the 17 recesses was only 0.34%. Amongst the uneven recesses present, the sphenoidal rostrum's recess (61.15% of the patients) and the inferior clinoid recess (56.42%) were the most common. Amongst the even recesses present, the lateral recess was prevalent in the majority (65.88%), whereas the posterior clinoid process' recess was the least common (9.8%). Presence of the recesses might facilitate access to the cranial fossae; hence, comprehensive evaluation of the sphenoid sinuses is of immense importance in order to avoid unnecessary drills through the hard bone, which could potentially damage the nearby neurovascular structures.

Agenesis of the sphenoid sinus and a single sphenoid sinus: a computed tomography anatomical evaluation.

Sphenoid sinuses are pneumatic spaces within the body of the sphenoid bone. Their development begins in the prenatal life and continues until the adulthood. Agenesis of the sphenoid sinuses is a situation in which they are undeveloped. On the other hand, a single sphenoid sinus lacks the presence of the main septum, leading to the formation of a single antrum. Contemporary use of transnasal transsphenoidal approaches for the pituitary surgery, as well as functional endoscopic sinus surgery urges medical professionals to be well acquainted with the aforementioned variant. Paranasal sinuses of 300 patients (150 females, 150 males) were evaluated using computed tomography, without the use of contrast medium. Inclusion criteria involved absence of any identifiable pathology within the sphenoid sinuses and age over 18 years. Subgroup analysis involved probing for potential sources of heterogeneity, namely gender. In the whole research material of 300 patients, agenesis of the sphenoid sinuses was noted in 1% of the patients. No statistically significant differences were noted between the absence of the sphenoid sinuses and gender (p = 0.999). A single sphenoid sinus was found in 0.33% of the patients. There were no statistically significant differences found between the presence of fully developed sphenoid sinuses and gender (p = 0.498). Both agenesis of the sphenoid sinuses and a single sphenoid sinus are rare anatomical variants. Adequate planning for transsphenoidal surgeries with preoperative medical imaging is of essence in order to perform a safe and quality procedure.

Sphenoid ridge meningioma presenting as ischemia stroke

Ischemic stroke as the presenting feature of sphenoid ridge meningioma is extremely rare.

Association between the developing sphenoid and adult morphology: A study using sagittal sections of the skull base from human embryos and fetuses.

The developing sphenoid is regarded as a median cartilage mass (basisphenoid [BS]) with three cartilaginous processes (orbitosphenoid [OS], ala temporalis [AT], and alar process [AP]). The relationships of this initial configuration with the adult morphology are difficult to determine because of extensive membranous ossification along the cartilaginous elements. The purpose of this study was therefore to evaluate the anatomical connections between each element of the fetal sphenoid and adult morphology. Sagittal sections from 25 embryos and fetuses of gestational age 6-34weeks and crown-rump length 12-295mm were therefore examined and compared with horizontal and frontal sections from the other 25late-term fetuses (217-340mm). The OS was identified as a set of three mutually attached cartilage bars in early fetuses. At all stages, the OS-post was continuous with the anterolateral part of the BS. The BS included the notochord and Rathke's pouch remnant in embryos and early fetuses. The dorsum sellae was absent from embryos, but it protruded from the BS in early fetuses before a fossa for the hypophysis became evident. Although not higher than the hypophysis at midterm, the dorsum sellae elongated superiorly after gestational age 25weeks. In early fetuses, the AP was located on the side immediately anterior to the otic capsule. The AT developed on the side immediately posterior to the extraocular rectus muscles. At late term, the greater wing was formed by membranous bones from the AT and AP. The AT and AP formed a complex bridge between the BS and the greater wing. A small cartilage, future medial pterygoid process (PTmed) was located inferior to the AT in early fetuses. At midterm, one endochondral bone and multiple membranous bones formed the PTmed. The lateral pterygoid process (PTlat) was formed by a single membranous bone plate. Therefore, we connected fetal elements and the adult morphology as follows. (1) Derivative of the OS makes not only the lesser wing but also the anterior margin of the body of the sphenoid. (2) Derivatives of the BS are the body of the sphenoid including the sella turcica and the dorsum sellae. (3) Most of the greater wing including the foramen rotundum and the foramen oval originate from the AT and AP and multiple membranous bones. (4) The PTmed originate from endochondral bones and multiple membranous bones, while the PTlat derive from a single membranous bone.

Visual Outcomes in Surgically Treated Intracranial Meningiomas.

Intracranial meningiomas that arise from the medial sphenoid ridge, anterior clinoid process, tuberculum sellae, or planum sphenoidale often impair vision by compressing the optic nerves and optic chiasm. Although many studies have reported visual outcome following surgery for these tumors, documentation has often been incomplete and not validated by patient self-report. Retrospective study of 40 patients drawn from a single, academic, medical center. We used a unique method of assessing visual outcome based on whether the change in visual function affected the preoperatively better-sighted or worse-sighted eye in the belief that this method would correlate with effects on activities of daily living (ADL). To elicit patient self-reports of those effects, we conducted telephone interviews of 25 patients with a standard questionnaire. We also assessed putative ophthalmic, imaging, and surgical predictors of visual outcome. Visual improvement occurred in 61% of patients with preoperative monocular visual dysfunction, but only 22% of patients reported improvement in their ability to conduct ADL, and 17% lost vision. Visual outcomes were better in patients with preoperative binocular visual dysfunction, where visual improvement occurred in 73% and no patient lost vision in the preoperatively better-sighted eye. However, only 27% of patients with preoperative binocular visual dysfunction reported improvement in their ability to conduct ADL. Long duration of vision impairment, presence of optic disc pallor, large tumor size, and imaging-based preoperative optic canal involvement did not preclude a favorable visual outcome. Aggressive surgical reduction in displacement of the optic nerves was not necessary to obtain a favorable visual outcome and sometimes led to an unfavorable visual outcome. In this study, surgery often improved vision, especially in patients with preoperative binocular visual dysfunction. But patients indicated that the effect on their ability to perform ADL was more modest. Moreover, 17% of patients with preoperative monocular visual dysfunction lost vision in the only affected eye, often to a considerable degree. In those patients, surgery would be justified primarily to relieve the concern of having a large brain tumor and to prevent tumor growth. Preoperative ophthalmic and imaging features poorly predicted visual outcomes. Favorable visual outcomes occurred without aggressive surgical debulking of the tumors.

Incidence, Clinicopathological Profile and Location - Based Outcome of Intracranial Meningiomas: 10-Year Institutional Study with Review of Literature

Abstract Intracranial meningiomas are the most common extra-axial tumors, representing 15% of all brain tumors. Arising from the arachnoid cells, and common in middle-aged women, 90% meningiomas are benign. We conducted a 10-year study on 183 cases of intracranial meningiomas and observed a lower and decreasing trend; the mean age was 43.3 years but there was also a significant incidence in young females. Parasagittal/falx (29%), sphenoid ridge, convexity meningiomas and middle cranial fossa locations were more common. Histopathologically, meningothelial meningioma was the most common. Benign (WHO I) tumors were found in above 90%, atypical (WHO II) in 5% cases, and malignant (WHO III) in &lt; 4% patients. Most patients underwent Simpsons Grade I excision (35.6%) with dural reconstruction because of late presentations. Posterior fossa meningiomas were mostly benign, while intraventricular ones were mostly malignant with highest postoperation mortality. Mortality in operated patients was 9.8% but was highest in anterior fossa tumors (12.5%).

Sphenoid ridge meningioma presenting as ischemia stroke

A previously healthy 49-year-old woman presented to the emergency room with acute onset of left hemiparesis and dysarthria. Neurological examination showed a left central-type facial palsy. The muscle power grade 3 in the upper limbs and grade 4 in the lower limbs. Complete blood count, chest radiograph, ECG, echocardiogram and a duplex Doppler ultrasound scan of the carotid artery on the symptomatic left side were also normal. Magnetic resonance imaging (MRI) with angiography (MRA) (A,B,C,D,E,F) confirmed the left sphenoid wing mass that had displaced and distorted the left middle cerebral artery (MCA) postero-superiorly, thereby resulting in an acute thromboembolic MCA territory infarct. The patient underwent Simpson grade III resection through the pterional approach. The vessel compression was resolved, but the hemiparesis persisted. The pathology revealed a meningothelial meningioma. She was maintained on oral aspirin at 160 mg/ day, after a 6-month rehabilitation programme, the patient recovered with mild paresis in the left upper extremity. Meningiomas may present with slowly progressive signs of neurological deficit, headache or focal seizures. Exceptionally, they may compress surrounding major cerebral blood vessels and compromise cerebral blood flow resulting in acute neurological symptoms attributable to vascular insufficiency of a specific cerebral blood vessel thereby simulating classical ischemia stroke.

Detailed Arterial Anatomy and Its Anastomoses of the Sphenoid Ridge and Olfactory Groove Meningiomas with Special Reference to the Recurrent Branches from the Ophthalmic Artery.

Detailed arterial anatomy of the sphenoid ridge and olfactory groove meningiomas is complicated due to the fine angioarchitecture and anastomoses between each feeder. Herein, we present details of the arterial anatomy and the relationships of feeders in these lesions. This study included 20 patients admitted to our department between April 2015 and March 2020. Conditions of subjects consisted of 16 sphenoid ridge meningiomas and 4 olfactory groove meningiomas. We mainly analyzed arterial anatomy using 3D rotational angiography and slab MIP images of these lesions. We also analyzed the anastomoses of each feeder. We found that 19 (95%), 15 (75%), and 15 (75%) lesions had feeders from the ophthalmic, internal carotid, and external carotid arteries, respectively. As feeders from the ophthalmic artery, recurrent meningeal arteries were involved in 18 lesions (90%). Fifteen lesions (75%) had anastomoses between each feeder. Most of the meningiomas in the sphenoid ridge and olfactory groove had feeders from the ophthalmic and internal carotid arteries. There were various anastomoses between each feeder. This is the first report to demonstrate the detailed arterial anatomy and frequency of recurrent branches from the ophthalmic artery and their anastomoses using detailed imaging techniques.

Clinicopathological characteristics of intracranial meningiomas

Background: Meningioma comprises 25-30% of total central nervous system tumors detected. Ninety percent of meningiomas are benign, 6% are atypical, and 2% are malignant. Complete resection is often curative.&#x0D; Objectives: The objective of this study is to give ideas about the descriptive epidemiology, clinical presentation and histopathology of current scenario at National Neurosurgical Referral Center, Nepal.&#x0D; Methods: This is a prospective study from the period of January 2015 to September 2019 in the department of neurosurgery, National Academy of Medical Science, Bir Hospital. Inclusion criteria consists of all the histopathological proven cases of meningioma during the study period.&#x0D; Result: A total of 150 meningioma cases were operated during the study period. The average age of presentation was 42 years. Male to female ratio was 1:2. Most common affected age group was 30-50 years. The most common clinical symptoms for intracranial meningioma were headache followed by vomiting and paresis. Among intracranial meningioma, the most common location was convexity meningioma followed by sphenoid wing meningiomas and parasagittal meningiomas. Most common histopathological variety encountered was transitional meningioma, World health organization grade I.&#x0D; Conclusion: Meningiomas are slow growing, extra-axial tumor, usually benign which are most commonly located along convexities, sphenoid ridge and parasagittal area. Most are cured if completely removed, which is not always possible.