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"planum sphenoidale meningioma" OR "olfactory groove meningioma" surgical outcome
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planum sphenoidale meningioma treatment options symptoms surgery
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Summary of the Report
This is an MRI Brain (plain, non-contrast) report for a 67-year-old woman (Anantha Brahmeswaramma), done at Aditya Medicare Hospitals on 12-Aug-2026. Key findings:
- Lesion: A 49 x 39 mm, well-defined, mildly lobulated mass centered at the planum sphenoidale (skull base, in front of/above the pituitary gland), with a broad dural base.
- Signal characteristics: Iso-intense on T1, T2, and FLAIR, with no diffusion restriction and no blooming (no calcification/hemorrhage) - this signal pattern is classic for a meningioma, not a more aggressive tumor.
- Local effects: Minimal surrounding brain edema on the left side, and the mass is mildly extending ("insinuating") toward the sellar region (near the pituitary). It is pressing on and displacing nearby frontal lobe sulci and the frontal horn of the left lateral ventricle - this is a mass effect from the tumor's size, not invasion into the brain itself (it remains "extra-axial," i.e., outside the brain tissue, arising from the dura).
- Everything else is normal: rest of the brain, posterior fossa, cerebellopontine angles, basal ganglia/thalami, and no extra-axial fluid collections.
Impression: Large skull base, dural-based, extra-axial lesion, most consistent with a planum sphenoidale meningioma. The radiologist recommends a contrast-enhanced MRI to better characterize the tumor and determine its relationship to the pituitary gland, cavernous sinus, and internal carotid artery (ICA) - this is standard next-step imaging before any treatment planning.
What is a planum sphenoidale meningioma?
Meningiomas are tumors arising from the dura (the membrane covering the brain), and they are the most common primary brain tumor overall - about 35% of all primary brain tumors, and the vast majority (grade 1, WHO classification) are slow-growing and benign. The planum sphenoidale is a skull-base location just in front of and above the pituitary gland/optic chiasm, closely related to the olfactory groove and tuberculum sellae - Bailey and Love's Short Practice of Surgery and K. J. Lee's Essential Otolaryngology group these together as "anterior skull base meningiomas."
On MRI they are typically iso-intense to brain on T1/T2 with homogeneous contrast enhancement and often a "dural tail" sign - exactly matching what's described in this report (minus the contrast enhancement, since this was a plain study).
Typical symptoms from this location
Because of where it sits (near the optic nerves/chiasm and pituitary stalk), tumors in this region classically cause:
- Progressive, painless vision loss (from optic nerve/chiasm compression) - often a junctional scotoma or bitemporal visual field defect
- Headache
- Loss of sense of smell (more typical if it extends toward the olfactory groove)
- Personality/behavioral changes if there's significant frontal lobe compression
- Endocrine/pituitary dysfunction if it compresses the pituitary stalk
The frontal lobe compression and left-sided edema noted in this report raise the possibility of some frontal lobe symptoms; sellar insinuation raises the possibility of pituitary/visual pathway involvement, which is exactly why the radiologist wants the contrast MRI to map its relationship to the optic apparatus, cavernous sinus, and ICA before surgery.
Management
According to Mayo Clinic and Pacific Neuroscience Institute guidance, and consistent with the textbook sources:
- Observation with serial imaging can be reasonable if the tumor is small/asymptomatic, but at ~5 cm with mass effect on the frontal lobe and ventricle, this lesion is generally considered symptomatic/significant and surgery is usually recommended.
- Surgery (maximal safe resection) is the primary treatment for symptomatic planum sphenoidale/tuberculum sellae meningiomas, typically via a supraorbital ("eyebrow") craniotomy or an endoscopic endonasal (through the nose) approach, depending on the tumor's relationship to the optic nerves and carotid arteries. Complete removal rates for tumors in this specific location (planum sphenoidale/tuberculum sellae) are relatively favorable compared to more posterior/lateral skull base sites like the cavernous sinus.
- Radiotherapy (including stereotactic radiosurgery) is used for residual/recurrent tumor, or in patients who are poor surgical candidates.
Recent systematic reviews (2023-2025, PMIDs 37500988, 40439793) focus on olfactory nerve preservation and cognitive/behavioral outcomes after surgery for this class of anterior skull base meningiomas - relevant if smell preservation or cognitive function become concerns during surgical planning, though they don't change the basic first-line approach of resection for a symptomatic lesion.
Next steps
- Follow the radiologist's recommendation: get the contrast-enhanced MRI brain to define the tumor's extent and its relationship to the pituitary gland, cavernous sinus, and internal carotid artery.
- Referral to a neurosurgeon (ideally one with skull-base/anterior fossa experience) for surgical planning.
- Formal ophthalmologic exam with visual field testing is often done given the tumor's proximity to the optic pathways, along with baseline endocrine/pituitary function tests since it is insinuating toward the sellar region.
Important: This is an imaging report and interpretation, not a substitute for evaluation by the patient's treating neurosurgeon or neurologist, who will integrate the imaging with the clinical exam (vision, smell, neurological status) and the upcoming contrast MRI to finalize a management plan.
- Bailey and Love's Short Practice of Surgery, 28th Ed.
- K.J. Lee's Essential Otolaryngology, Ch. Neurosurgery
- Kanski's Clinical Ophthalmology, 10th Ed., p. Meningioma
- Cummings Otolaryngology Head and Neck Surgery, Meningiomas section
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