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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.
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The sphenoid bone is located in the central skull base and forms part of the floor of the anterior and middle cranial fossae. The optic foramen, superior orbital fissure, foramen rotundum, foramen ovale and foramen spinosum are found within this complex bone. These foramina form important transition zones between intracranial and extracranial structures. Imaging plays a central role in delineating lesions within the sphenoid bone and the associated fissures and neural foramina. The purpose of this pictorial review is to highlight the pertinent normal and pathological anatomy of the sphenoid bone.
The sphenoid bone represents a complex structure in terms of anatomy and embryology. Indeed, it is formed by the fusion of different primordia whose embryonic origins are different. In mammals, it is possible to distinguish two components of this bone: the orbitosphenoid and the basi-post-sphenoid derive from the cephalic mesoderm whereas the alisphenoid and the basi-pre-sphenoid are from neural crest cell origin. The genetic control of the development of these two components is different further increasing the heterogeneity of these components. The sphenoid bone has been linked with several developmental diseases: chordomas, tumors arising from notochordal remnants; persistence of the craniopharyngeal canal may result in the occurrence of trans-sphenoidal encephaloceles.
Aneurysmal bone cyst (ABC) is an uncommon benign lesion that rarely presents in the craniofacial region. Aneurysmal bone cysts represent nearly 1.4% of all bone tumors, and among those, only 3% are located in the cranium. In this study, we report on an ABC located in the sphenoid bone with superior nasal cavity and ethmoid extension. The presenting symptom of our patient was headache, followed by diplopia, loss of visual accuracy, and abduction restriction. We successfully resected the lesion by a combined subcranial-midfacial degloving approach without any complications or recurrence.
Aneurysmal bone cysts are vascular lesions that destroy and expand bone. We report a recently treated case of an aneurysmal cyst of the sphenoid bone. A 14-year-old girl presented with frontal headaches, bouts of nausea, and vomiting. Computed tomography and magnetic resonance imaging showed typical features of an aneurysmal bone cyst. Arterial embolization was undertaken before surgery. The endoscopic transnasal procedure used allowed the complete removal of the aneurysmal bone cyst. This use of minimally invasive surgery makes this case of interest to surgeons of the skull base and sinuses.
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.
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The sphenoid bone is a complex structure with an intricate embryologic origin. It is centrally located within the skull base and articulates with almost every structure in the skull and face. The sphenoid bone contains multiple foramina and fissures accommodating numerous vessels and nerves. This report reviews the embryology of the sphenoid bone and its normal postnatal changes, and describes the normal anatomy of the sphenoid bone and its numerous foramina and fissures. Computed tomography (CT) and magnetic resonance (MR) are used to illustrate developmental changes and normal anatomy.
In this paper, the anatomy of the sphenoid bone and surrounding and associated structures is described. The sphenoid bone is centrally located in the skull base. The anatomy of the bony canals, foramina and fissures that run through the sphenoid bone or run along its borders must be known. The osseous anatomy can be studied using CT. On the other hand, MR is mandatory for visualization of the vascular and nervous structures in and around the sphenoid bone.
The removal of sphenoid bone parts was performed by the admitting neurosurgeons on a patient who presented an optic nerve compression syndrome. Beside the orbital trauma, an extensive midfacial trauma was sustained with dislocated multifractures of the zygomatic complex. In a secondary procedure, the orbital cavity was reconstructed successfully using 3 different methods of computer-assisted surgery. First, the reconstruction of the zygomatic complex was controlled intraoperatively by a virtual model obtained by mirroring the unaffected side to the affected side. Second, extracorporeal bone parts were virtually preoperatively relocated and orientated. The reconstruction of the orbital cavity by the insertion of these bony fragments was performed intraoperatively as planned after the zygomatic complex reconstruction. Third, the virtual reconstruction of the orbital floor was performed using preoperatively individually bent and preformed orbital titanium mesh. Combinations of these methods demonstrate the practical and high value of computer-assisted surgery in complex reconstructive craniofacial surgery.
The greater wing of the human sphenoid bone is pierced by several foramina, which contain, as a main element, the venous anastomoses between the interior of the skull and the extracranial veins. Since data concerning these foramina are scarce in the literature, studies comprising the frequency of occurrence and morphology of the foramina of the greater wing of the human sphenoid bone were undertaken on 100 macerated skulls. We found that the foramen ovale is divided into 2 or 3 components in 4.5% of cases. Moreover, the borders of the foramen ovale in some skulls were irregular and rough. This may suggest, on radiological images, the presence of morbid changes, which might be the sole anatomical variation. Concurrent with the foramen ovale are accessory foramina. The foramen of Vesalius and the cavernous foramen were present in 17% and 33% of cases, respectively. The foramen of Vesalius was always single and the cavernous foramen also occurred in multiple form. The foramen spinosus and the foramen rotundum occurred as permanent elements of the skulls studied. The mean area of the foramina measured, excluding the foramen ovale, was not considerable, which may suggest that they play a minor role in the dynamics of blood circulation in the venous system of the head.
We present 2 patients with giant cell reparative granuloma (GCRG) of the sphenoid bone. The first patient is an 8-year-old boy with involvement of the greater wing, and the second is a 53- year-old man with a lateral pterygoid plate mass. Both patients presented with rapid expansion of lytic bone lesions, which had solid and cystic components and lacked matrix calcification. Biopsies were indeterminate for definitive diagnoses. The radiologic appearance, location, and incidence of the lesions, and the patient's age and medical history are helpful aids in narrowing the differential diagnosis of sphenoid bone lesions. However, the imaging and, occasionally, even the histologic findings may not suggest the specific diagnosis of GCRG, which must be added into the differential diagnosis of rapidly enlarging cystic bone lesions of the sphenoid bone.
Giant cell tumor (GCT) of the sphenoid bone is a relatively rare entity and metachronous multicentric GCT of the sphenoid is even rarer; we are aware of only 3 previous cases in the literature. We describe here a tumor of the sphenoid bone that was identified 15 years after multiple resections of a GCT of the left inferior pubic ramus. Correlation is made between the histopathologic findings, MR imaging of the brain, CT of the head, and fusion positron-emission tomography (PET)/CT scan performed with fluorine-18 fluoro-2-deoxy-D-glucose (18F-FDG). This report is the first to describe the appearance of a GCT of the sphenoid bone on a fusion PET/CT examination. High metabolic activity in the base of the skull adjacent to the middle cranial fossa was demonstrated in a fashion similar to that of the known pelvic lesion. This case also demonstrates that the increased metabolic activity seen in a GCT of the sphenoid bone may be partially obscured by the adjacent physiologic high metabolic activity of the brain.
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.
The purposes of this study were to evaluate the asymmetry of the sphenoid bone and to determine its suitability as a reference for analyzing asymmetry of the skull. Thirty-seven dry skulls from India were divided into group A (n = 18), with a right-left length discrepancy of less than 2 mm for both the external acoustic meatus-frontozygomatic suture and external acoustic meatus-subspinale, and group B (n = 19), with a right-left length discrepancy of more than 2 mm for either of these 2 parameters. The skulls were then examined with regard to the percentage of asymmetry of the sphenoid bone, the angles between the cranial base and the facial axis, and the distance between reference surfaces of the sphenoid bone and facial landmarks by 3-dimensional measurement system. The following results were obtained: 1. Asymmetry of the sphenoid bone, while slight, was found in both groups. There were no significant differences between the 2 groups. 2. The cranial base and the facial axis did not form a right angle in group A, and there were no significant differences between the 2 groups. 3. The distances between reference surfaces of the sphenoid bone and the lower landmarks of the facial bone were greater than those of the upper landmarks. 4. The external acoustic meatus was the most suitable reference for analysis of craniofacial asymmetry.
The authors report a case of cranial EH occurred in the left sphenoid bone that was totally excised without transfusion. A 26-year-old woman presented with a 1-year history of progressing exophthalmos in the left eye. A cranial X-ray showed a mixed osteolytic and sclerotic expansile mass lesion in the left sphenoid bone. Neuroradiologic imaging study revealed a left temporosphenoidal extra-axial expansile mass lesion with heterogeneous enhancement after contrast enhancement associated with destruction and erosion of the temporal and sphenoid bones. The cerebral parenchyma and orbital contents were compressed without any sign of infiltration. Bone scan showed hot uptake in the left orbital region. Angiogram demonstrated marked neoplastic angiogenesis from the middle meningeal artery and other branches of left external carotid artery, for which preoperative embolisation was tried in vain. Cranio-orbito-zygomatic approach was undergone in two stages because of the patient's religious belief (patient was Jehovah's witness) and profuse bleeding during the first surgery. Two weeks after initial operation, second surgery was carried out with total excision of the residual mass in the left orbital ridge. Histopathological examination revealed typical epithelioid cell cords or nests in myxoid stroma with a positive immunoreactivity to factor VIII-related antigen. The authors report an unusual case of EH involving sphenoid and temporal bone in a young woman. Preoperative embolisation is thought to be absolutely essential before removal. Because there is no convincing data to advise radiation/chemotherapy, total resection and close follow-up may be reasonable.
BACKGROUND: Giant cell tumors rarely occur in the sphenoid bone. When they do occur in the base of the skull, surgical treatment is frequently difficult and therefore, the use of adjuvant therapy is important. However, there remains no optimal management regimen for giant cell tumors of the sphenoid bone. CASE DESCRIPTION: Two cases of a giant cell tumor involving the sphenoid bone that responded well to chemotherapy using adriamycin after a partial removal of the tumor are presented. In the first patient, the tumor was partially removed via a transcranial subfrontal approach and a transnasal transsphenoidal approach. In the second patient, the tumor was partially removed through a transcranial subfrontal approach. Both tumors demonstrated histologic features typical of giant cell tumors. The patients subsequently received adjuvant chemotherapy using adriamycin alone in the first patient, and chemotherapy combined with radiotherapy in the second patient. Partial regression of the tumors was later confirmed on a computed tomography (CT) scan after chemotherapy. In both patients, tumors have been stable for more than 12 years despite an incomplete removal of the tumors. CONCLUSION: Based on the above findings, postoperative adjuvant chemotherapy using adriamycin may be effective for incompletely resected giant cell tumors of the sphenoid bone.