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Sphenoidal erosions due to tuberculosis are reported in four young coloured children. The lytic destruction is emphasized for refence texts indicate that tuberculosis produces a sclerotic reaction when extending to the skull base. Tuberculous osteitis of the skull occurs particularly in coloured children and adolescents. It should be considered when destructive skull lesions are seen in these patients.
Fractures of the sphenoid bone occur following injury to the orbit and base of the skull. Such fractures are important since they can cause loss of vision and damage to various neural and muscular tissues. Ocular injury is also commonly associated. This paper reviews the hospital records of 112 consecutive patients with fractures of the base of the skull for the cause, frequency of signs and symptoms, and treatment of the sphenoid bone injury. Various deformities and dysfunctions are correlated with imaging data and classified to describe specific clinical syndromes. Several cases of sphenoid bone fracture serve as examples of diagnostic and treatment techniques.
Anatomically, the sphenoid bone can be characterized as the center of the skull. It represents the crossroads where various factors which contribute--each in its own way--to the craniofacial complex, are combined. The morphology of the sphenoid bone is changeable and the opinion that it serves the functional needs for the viability of the individual was formulated in the literature. The findings from the study of 20 patients exhibiting various syndromes that affect the craniofacial complex lead to the conclusion that there is an admirable adaptability and mutual support of the elements which contribute to the formation of the craniofacial complex, the sphenoid bone being one of them, with significant potential and effect on adjacent structures.
Giant cell tumors of the sphenoid are rare; there are 36 previously reported cases. We report two cases of these tumors in women in their thirties, both associated with pregnancy. In the first patient, the tumor was removed via a transnasal transsphenoidal approach. In the second patient, a Le Fort maxillotomy was required. In these cases, an interoperative diagnosis was made, and in both, this diagnosis directed surgical tactics towards a more radical excision. Reported experience with the outcome of giant cell tumors in other sites suggest that total removal by curettage is the ideal treatment; the main principle is to prevent local recurrence because the metastatic potential of this tumor is low. A combination of surgery and radiotherapy is essential for giant cell tumors occurring in sites where access is difficult, such as the sphenoid bone. Previous objections to radiotherapy have included poor response rate and malignant change. Recent studies suggest that neither of these problems is significant when modern therapeutic techniques are employed.
The article discusses the changes of the bone plate of the sphenoid bone in the upper third of the carotid groove; the plate separates the siphon of the internal carotid artery from the cavity of the sphenoid sinus. Both carotid grooves were examined on blocks removed from the base of the skull of 65 cadavers and on 45 macerated skulls. Two types of bone changes were found in the upper third of the carotid groove, namely, osteoporosis and perforating defects. Osteoporosis was revealed in 50 grooves and defects only in the upper third in 45 grooves. Osteoporosis and defects were encountered about five times more frequently between the ages of 41 and 60 than till the age of 40 and 10 times more frequently after the age of 60. The same relations were found when osteoporosis was combined with a defect. These bone defects are an anatomical precondition for profuse nasal bleeding because the wall of the internal carotid artery ruptures during a craniocerebral trauma and blood flows freely from it into the sphenoid sinus and then into the nasopharynx.
The case of a patient who developed osteosarcoma in the sphenoid bone 15 years after radiation therapy for a craniopharyngioma is reported. Radiation-induced osteosarcoma of the sphenoid bone has not been reported previously. Reported cases of radiation-induced osteosarcomas are reviewed.
The topographic and internal anatomy of the sphenoid bone is reviewed with an emphasis on the relationships important to the transcranial and subcranial surgical approaches to the sphenoid sinus, sella turcica and cavernous sinus. A stepwise method of study and dissection is outlined. The equipment and materials needed for sphenoid bone dissection in the laboratory are reviewed.
We report the case of a 23-year-old man with a giant-cell tumor of the sphenoid bone. The radiologic manifestations consisted of an expansile mass arising from the sphenoid bone with extension into the cranial cavity and the nasopharynx. The findings with computed tomography and magnetic resonance imaging best reflected respectively the osseous and soft-tissue extent of the disease.
Four patients who sustained crushing fractures of the sphenoidal bone had angiographic evidence of venous occlusions of the cavernous area. Signs depended upon the type of basal venous and cavernous anatomy. The diagnosis can be made by demonstrating abrupt cutoff of veins in the cavernous region, preferred retrograde flow of the anterior cavernous sinus, direct venous hemorrhage, and venous stasis.
A case is reported where the clinical symptomatology as well as the ophthalmological, radiological, endocrinological, and scintigraphic results offered significant evidence in favor of the presence of a tumor in the sellar region. The diagnosis of a pyocele originating in the sphenoid bone could be established intraoperatively only. Cysts originating in the sphenoid bone are described as what is usually called an "orbital inlet syndrome" from which the present case differs in some respects.
The authors report a boy aged 9 years in whom a giant meningioma of the small wing of the sphenoidal bone was removed surgically. Attention is called to the rarity of these tumours in the first decade of life. Developmental retardation, speech beginning at the age of 4 years, large head and epileptic seizures developing at the age of 7 years without signs of intracranial hypertension suggested the possibility of organic brain disease and development of massive hemiparesis, speech disturbances and choked disc in the last period of the disease were the cause of referral of the child to a neurosurgical unit. Plain skull films and angiography demonstrated changes typical of raised intracranial pressure and presence of an expanding lesion in the left cerebral hemisphere. Meningioma was found on operation hidden within the left frontal and temporal lobes but connected by means of a narrow band to the dura of the small wing of the sphenoidal bone. A good result was obtained. Follow-up examination after 2 years demonstrated slight neurological abnormalities and a very good general state of the child.
A case of giant cell tumour of the sphenoid bone is reported. Besides the familiar presentation with headaches, ocular manifestations, and upper cranial nerve lesions, this case showed previously undescribed features such as grand mal seizures, hemiparesis with facial palsy, and dural extension. The reported high incidence in females is questioned. The tumour histologically showed some cartilage.
Nuclear scattering radiographs of a portion of a spine and a sphenoid bone have been obtained using a 1 GeV proton beam. The ability of the method to yield three-dimensional representations is illustrated by three series of adjacent pictures corresponding to the three orthogonal planes (elementary volume: 5.2 mm3 and 0.9 mm3). The sensitivity of the method is discussed. Nuclear scattering radiographs are compared with ones obtained by conventional X-ray tomography and computed tomography. Nuclear scattering radiography also may be used to analyze the partition of hydrogen within the tissures. Hydrogen radiographs obtained in this way are shown.
The clinical and histological features of two cases of giant cell tumor of the sphenoid bone are described. Both presented with similar symptoms and signs, comparable to previously described cases. The problems in histological differential diagnosis are discussed and radiotherapy as the treatment of choice is suggested.
A case of the rare giant cell tumour involving the sphenoid bone is reported. The usual presentation of these tumours is headache and cranial nerve deficits. This 25-year-old lady presented with oligomenorrhoea and galactorrhoea. Investigations demonstrated an asymptomatic erosive mass lesion in the sphenoid with suprasellar extension and extension into the nasopharynx. The tumour was partially resected via the transphenoidal route. The differential diagnosis and treatment of these lesions are discussed.
Three cases of giant cell tumor of the sphenoid bone are reported together with a revision of the previously reported cases in the neurosurgical literature. The importance of this tumor in the neurosurgical pathology is stressed, mainly to the impossibility of a correct diagnosis on a clinical and radiological basis. A good prognosis is possible with a least agressive surgery, transphenoidal biopsy and decompression, folowed by radiotherapy.
A total of 43 operations were carried out in 37 patients with a meningioma of the wing of the sphenoid bone or a Tuberculum sellae meningioma. In 18 cases the primary extirpation could be performed and in 18 patients the intervention only consisted of a resection. The removal of any meningioma tissue was classified as an extirpation. If a residual part of whatever size of the tumour was left, the intervention was declared to be a resection. Six patients died, 31 were submitted to a control examination. All 14 patients in whom an extirpation was carried out showed no signs of a renewed tumour growth within the observation period of 2 to 10 years after obtaining the computer-tomographical findings. In six of the 16 patients in whom only a resection was possible a second operation was carried out. An extirpation could be performed in four of these patients. Among the remaining ten patients (period of observation 2 to 6 years) five showed a further increase of the tumour size, in four patients no tendency of a growth could be proved, and one patient had died. In the postoperative assessment we distinguish between a residual tumour and a new tumour growth. A renewed tumour growth is present if the computer tomogram shows signs of meningioma tissue although earlier postoperative checks had not shown this. In the postoperative control examinations the residual tumours should be differentiated with respect to their importance as (a) a residual tumor with a growth tendency and (b) a residual tumour without a growth tendency.
A rare case is reported of an osteoma protruding into the pterygomandibular space from the lateral pterygoid plate of the sphenoid bone. The procedure of the diagnosis and treatment is described. In this case, computed tomography (CT) was the most useful in making a differential diagnosis. That the pulling force of the medial pterygoid muscle might be a causative agent in the growth of this osteoma is considered.