Bony Hyperostosis Recurrence after Complete Resection of Sphenoorbital Meningioma

Abstract

Bony hyperostosis is commonly associated with meningioma growth and is considered one of the characteristic signs on imaging; however, recurrence of meningiomas in the sphenoorbital area, including associated hyperostosis, is typically precluded by gross total resection of the lesion. This 63-year-old man presented with progressive double vision and proptosis in the right eye. He underwent frontotemporal craniotomy and partial removal after magnetic resonance imaging demonstrated a right sphenoorbital meningioma extending to the orbit and middle fossa. He had transient improvement of his symptoms postoperatively but experienced a progressive recurrence of symptoms and new onset of right facial hypoesthesia in the distribution of V1 and V2. We performed a right frontotemporal craniotomy with removal of the nodular part, as well as extensive drilling. Although the postoperative computed tomography scan revealed a gross total resection, the five-year follow-up scan demonstrated a recurrent hyperostosis in the region of the lesser and greater sphenoid wings, the middle cranial fossa floor with inferior extension toward the infratemporal fossa, and the sphenoid sinus wall. After another redo surgery, the patient continues to be monitored with yearly imaging. The extent of surgical resection is one of the most important predictors of meningioma recurrence postoperatively, and cases of recurrence after gross total resection are rare.

Keywords: hyperostosis; meningioma; recurrence; skull base; sphenoorbital.

Figure 1. Preoperative computed tomography scan bone window images

Axial cuts showing extensive hyperostosis of the lesser and greater sphenoid wing, lateral orbital wall, clinoid, and middle cranial fossa floor (arrows).

Figure 2. Postoperative computed tomography scan bone window images

Axial cuts showing complete removal of the sphenoid bony hyperostosis, lateral and superior orbital wall, clinoid, and floor of the middle cranial fossa (arrows).

Figure 3. Computed tomography of the orbit

Axial cuts showing recurrent bony growth of the sphenoid wings, lateral sphenoid sinus wall, and middle cranial fossa floor (arrows).