THE PTERIONAL APPROACH IN A CASE OF PLANUM SPHENOIDALE MENINGIOMA

Meningiomas represent almost 15 percent of primary brain tumors and are the most common non-glial primary brain tumor. Parasellar meningiomas represent 5–10 percent of all intracranial meningiomas. They may arise from the diaphragma sella, tuberculum sellae, planum sphenoidale, medial lesser wing of sphenoid, anterior clinoid, clivus, and cavernous sinus (Smith 2005). Planum sphenoidale meningiomas are located anterior to and in proximity to the olfactory groove. For an optimal postoperative outcome planum, sphenoidale meningiomas must be diagnosed early, and the operative procedures performed promptly and with utmost care. Ideally, management is intended to preserve and improve vision and consists of total resection with no injury to the neighboring vital structures. We report the case of a 64-year-old woman who presented with progressive visual disturbance, impairment of visual acuity, visual field defects and diffuse headache. Gadolinium-enhanced T1-weighted MR images showed a well-defined, suprasellar solid mass, measuring 30/35/40 mm. The lesion was hyperintense on T1-weighted imaging with homogenous enhancement and a broad dural attachment to the planum sphenoidale. The planum sphenoidale meningioma was successfully resected using a left pterional approach. The intraoperative and postoperative courses were uneventful with a total recovery. Improvement of visual acuity was noted and the postoperative computer-tomography investigation showed total surgical removal with no residual tumor.