Hemangioendothelioma is borderline or intermediate type of vascular neoplasm. Hemangioendothelioma is rare lesion that constitutes less than 0.5% of the malignant tumors of bone. We present a case of low-grade hemagioendothelioma of the skull in a 29-yr-old woman. She had pain, diplopia and exophthalmos of the left eye. Radiographic images showed a relatively well-demarcated, expansile osteolytic lesion with irregularly thickened trabeculae and calcifications in the left greater wing of sphenoid bone. Histologically, the tumor was an infiltrative vasoformative lesion. The vessels are generally well-formed with open or compressed lumina surrounded by endothelial cells showing mild atypia. It lacked frequent mitotic figures and severe atypia. Although excessive bleeding occurred during the operation, the mass was totally resected. Postoperative radiation was not necessary. She is free of disease and well 6 months postoperatively.
Adult ; Bone Neoplasms/*pathology/radiography ; Female ; Hemangioendothelioma/*pathology/radiography ; Human ; Pregnancy ; Sphenoid Bone/*pathology

Bone Cysts ; diagnosis ; Bone Cysts, Aneurysmal ; diagnosis ; Humans ; Male ; Middle Aged ; Sphenoid Bone ; pathology

OBJECTIVE: To study the clinical manifestation, radiograph features, pathology, diagnosis and treatment of fibrous dysplasia in cranial bone. METHOD: A case of fibrous dysplasia involving sphenoid and occipital is reported and literature were reviewed. RESULT: The most common complaint were headache, proptosis, diplopia, or visual changes. Distinguishing features of fibrous dysplasia on CT include "ground-glass" appearance, bone fiber anisotrophy, aneurysmal bone cyst formation and thickness of the cranial cortices. Fibrous dysplasia could be exactly diagnosed by pathology. Computed tomography was also a choice for diagnosis. CONCLUSION Fibrous dysplasia involving the cranial bone can present in myriad ways. Modern imaging modalities and histopathologic analysis is required to make accurate diagnosis. Surgery, particularly in a challenging region such as sphenoid and occipital bone, should preserve the existing function for the patients with functional impairment or a cosmetic deformity.
Adult ; Fibrous Dysplasia, Polyostotic ; diagnosis ; diagnostic imaging ; pathology ; Humans ; Male ; Occipital Bone ; Radiography ; Sphenoid Bone

A rare case of telangiectatic osteosarcoma of the sphenoid bone was reported. The patient was a 27-year-old male and had suffered from left eye protrusion and diplopia for three months. Radiologically, a lobulated osteolytic lesion was located between sphenoid and left temporal bone. Pathologically, the tumor had multiloculated blood filled cystic vascular spaces and osteoid formation by malignant spindle osteoblast cells. The differential diagnosis of this rare entity from aneurysmal bone cyst was important radiologically and pathologically. This case is the second case of telangietatic osteosarcoma of the sphenoid bone followed by a case of Whitehead RE and Melhem ER in 1998.
Adult ; Aneurysm ; Bone Cysts ; Diagnosis, Differential ; Diplopia ; Humans ; Male ; Osteoblasts ; Osteosarcoma* ; Pathology ; Skull Base* ; Skull* ; Sphenoid Bone ; Temporal Bone

OBJECTIVE: To investigate the diagnosis and treatment of fibrous dysplasia (FD) involving the skull base. METHOD: The clinical data of 15 patients with fibrous dysplasia involving the skull base was retrospective analysis. RESULT: All patients were underwent CT examinations. FD involved orbital roof in 15 patients, ethmoidal bone in 15 patients, middle and lower nasal turbinate in 8 patients, frontal bone in 8 patients, sphenoidal bone in 6 patients, and maxillary bone in a patient. Although the optic canal was affected in 4 patients, only one patient had impaired vision. All the patients were treated by craniofacial approach. One patient with impaired vision was performed decompression of optic canal and had improved in vision. The titanium mesh was use for construction of skull base defect. There were not complications, such as infection, cerebral hemorrhage, etc. CONCLUSION It should be underwent surgical treatment for fibrous dysplasia involving skull base which resulted in clinical manifestations. Whether prophylactic decompression of optic canal is performed or notr depends on the patients clinical and radiological information.
Adolescent ; Adult ; Female ; Fibrous Dysplasia of Bone ; pathology ; surgery ; Frontal Bone ; pathology ; Humans ; Male ; Maxilla ; pathology ; Orbit ; surgery ; Retrospective Studies ; Skull Base ; pathology ; Sphenoid Bone ; pathology ; Young Adult

BACKGROUND: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. METHODS: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors’ diverse clinical experiences. RESULTS: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. CONCLUSIONS: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.
Humans ; Pathology ; Perioperative Care ; Plastics ; Skull Base ; Sphenoid Bone ; Surgeons ; Zygoma

Meningioma rarely manifests as a subarachnoid hemorrhage (SAH), and invasion directly into a major intracranial artery is extremely rare. To the best of our knowledge, meningioma presenting with an SAH associated with major intracranial arterial invasion has never been reported. We present a case of sphenoid ridge meningotheliomatous meningioma manifesting as an SAH without pathologically atypical or malignant features, due to direct tumor invasion into the middle cerebral artery.
Humans ; Male ; Meningeal Neoplasms/*complications/pathology ; Meningioma/*complications/pathology ; Middle Aged ; Middle Cerebral Artery/*pathology ; Neoplasm Invasiveness ; Skull Neoplasms/*complications/pathology ; *Sphenoid Bone ; Subarachnoid Hemorrhage/*etiology

BACKGROUNDSurgery of pituitary adenomas invading cavernous sinus has always been thought as a challenge due to the complex anatomical structures and high risk of complications. The purpose of this study was to evaluate endoscopic transsphenoidal approach to pituitary adenomas invading cavernous sinus.

METHODSThe clinical data of 22 patients who admitted to Xuanwu Hospital with pituitary adenomas invading cavernous sinus were analyzed retrospectively. All patients underwent endoscopic transsphenoidal surgery. To expose the surgical field sufficiently, the opening of sellar floor was exceeded the bone overlying the invaded cavernous sinus, and synthetic dura was used to repair and strengthen the sella floor for preventing the leak of cerebrospinal fluid.

RESULTSAmong 22 patients, total resection was achieved in 14, subtotal resection in 5, and partial resection in 3; no patient underwent insufficient resection. Visual symptoms improved in 7 of 9 patients. In one patient diplopia disappeared. Headache was relieved to various extents in all patients. No serious complications were found. Patient's hospital stay ranged from 7 to 20 days.

CONCLUSIONThese data suggest that the endoscopic transsphenoid approach is a safe, minimally invasive, and efficient surgical technique, which might be an important therapeutic strategy for the pituitary adenoms invading cavernous sinus.

Adenoma ; pathology ; surgery ; Adult ; Aged ; Cavernous Sinus ; pathology ; Endoscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neoplasm Invasiveness ; Pituitary Neoplasms ; pathology ; surgery ; Sphenoid Bone ; surgery

OBJECTIVETo investigate the clinical applied anatomy in the region of anterior clinoid process, and to improve the therapeutic efficacy of clinoidal tumors.

METHODSTwelve patients with large meningiomas located in clinoid were surgically treated via the extended anterior and middle fossa combined with epidural approach between January 1998 and August 2004. The surgical outcome and follow-up results were reviewed retrospectively. Supraorbital-posterional approach and cranioorbital zygomatic approach were used when tumors involved cavernous sinus. Anterior clinoid process was grinded with high-speed drilling. Supply of tumors were blocked extradurally. Tumors were resected intradurally.

RESULTSOf the 12 cases in large meningiomas located in clinoid, 8 cases had total removal of tumors, 3 patients had subtotal removal. Of the 10 patients with pre-operative severe visual deterioration, 6 patients was markedly improved, one patient unchanged and one patient worsened post-operatively. No death was found in this group.

CONCLUSIONSUsing epidural approach for clinoidal meningiomas and grinding anterior clinoid process was advantageous to block tumors base blood supply and detach infraclinoidal tumors from internal carotid artery. Supraorbital-pterional approach could minimize brain retraction and was advantageous to expose superior pole of giant tumors.

Adult ; Female ; Humans ; Male ; Meningeal Neoplasms ; pathology ; surgery ; Meningioma ; pathology ; surgery ; Middle Aged ; Neurosurgical Procedures ; methods ; Retrospective Studies ; Sphenoid Bone ; surgery ; Treatment Outcome

Running through the infratemporal fossa is the lingual nerve (i.e. the third branch of the posterior trunk of the mandibular nerve). Due to its location, there are various anatomic structures that might entrap and potentially compress the lingual nerve. These anatomical sites of entrapment are: (a) the partially or completely ossified pterygospinous or pterygoalar ligaments; (b) the large lamina of the lateral plate of the pterygoid process; and (c) the medial fibers of the anterior region of the lateral pterygoid muscle. Due to the connection between these nerve and anatomic structures, a contraction of the lateral pterygoid muscle, for example, might cause a compression of the lingual nerve. Any variations in the course of the lingual nerve can be of clinical significance to surgeons and neurologists because of the significant complications that might occur. To name a few of such complications, lingual nerve entrapment can lead to: (a) numbness, hypoesthesia or even anesthesia of the tongue's mucous glands; (b) anesthesia and loss of taste in the anterior two-thirds of the tongue; (c) anesthesia of the lingual gums; and (d) pain related to speech articulation disorder. Dentists should, therefore, be alert to possible signs of neurovascular compression in regions where the lingual nerve is distributed.
Cranial Fossa, Middle ; Foramen Ovale ; pathology ; Humans ; Ligaments ; pathology ; Lingual Nerve ; pathology ; Nerve Compression Syndromes ; complications ; pathology ; Ossification, Heterotopic ; pathology ; Paresthesia ; etiology ; Pterygoid Muscles ; pathology ; Sphenoid Bone ; pathology ; Tongue ; innervation