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Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report.

Publication ,  Journal Article
Tobias, S; Prayson, RA; Lee, JH
Published in: Neurosurgery
November 2002

OBJECTIVE AND IMPORTANCE: Necrotizing sarcoid granuloma (NSG) has been recognized as a histological variant of sarcoidosis. Two cases of neurosarcoidosis (NS) with NSG with concomitant systemic disease have been described previously. We present an unusual case of primary NS-NSG that resembled an en plaque cranial base meningioma. CLINICAL PRESENTATION: A 51-year-old man presented with a 3-month history of progressive left visual deterioration and proptosis. Brain magnetic resonance imaging demonstrated a large cranial base lesion occupying the left anterior clinoid process and sphenoid wing, extending to the left frontotemporal convexity. A second dura-based lesion was observed in the right parietal convexity. Both lesions enhanced homogeneously after administration of intravenous contrast medium. Magnetic resonance imaging characteristics were consistent with a typical clinoidal meningioma with an en plaque extension laterally. INTERVENTION: A left frontotemporal craniotomy with extradural removal of the anterior clinoid process was performed. When the dura was opened, a red fibrous mass was identified. Intraoperative histological analysis revealed the presence of necrotizing and noncaseating granulomas. Postoperatively, cerebrospinal fluid, erythrocyte sedimentation rate, C-reactive protein, and serum and cerebrospinal fluid angiotensin-converting enzyme values were normal. The search for acid-fast bacilli or fungi was negative. A diagnosis of primary NS-NSG was made. The patient began long-term high-dose corticosteroid therapy. One and a half years after surgery, his vision had improved significantly and the lesions were stable as revealed by magnetic resonance imaging. CONCLUSION: The first case of primary NS-NSG in the absence of systemic sarcoidosis is reported. NS should be included in the differential diagnosis of dura-based lesions resembling meningioma.

Duke Scholars

Published In

Neurosurgery

DOI

ISSN

0148-396X

Publication Date

November 2002

Volume

51

Issue

5

Start / End Page

1290 / 1294

Location

United States

Related Subject Headings

  • Skull Base
  • Sarcoidosis
  • Neurology & Neurosurgery
  • Nervous System Diseases
  • Middle Aged
  • Meningioma
  • Meningeal Neoplasms
  • Male
  • Humans
  • Diagnosis, Differential
 

Citation

APA
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ICMJE
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Tobias, S., Prayson, R. A., & Lee, J. H. (2002). Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report. Neurosurgery, 51(5), 1290–1294. https://doi.org/10.1097/00006123-200211000-00030
Tobias, Samuel, Richard A. Prayson, and Joung H. Lee. “Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report.Neurosurgery 51, no. 5 (November 2002): 1290–94. https://doi.org/10.1097/00006123-200211000-00030.
Tobias, Samuel, et al. “Necrotizing neurosarcoidosis of the cranial base resembling an en plaque sphenoid wing meningioma: case report.Neurosurgery, vol. 51, no. 5, Nov. 2002, pp. 1290–94. Pubmed, doi:10.1097/00006123-200211000-00030.
Journal cover image

Published In

Neurosurgery

DOI

ISSN

0148-396X

Publication Date

November 2002

Volume

51

Issue

5

Start / End Page

1290 / 1294

Location

United States

Related Subject Headings

  • Skull Base
  • Sarcoidosis
  • Neurology & Neurosurgery
  • Nervous System Diseases
  • Middle Aged
  • Meningioma
  • Meningeal Neoplasms
  • Male
  • Humans
  • Diagnosis, Differential