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

Samuel Tobias, Richard A. Prayson, Joung H. Lee, Allan H. Friedman, Amer Samdani, Henry Brem, Jack P. Rock, Bruce E. Pollock

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1290-1294
Number of pages5
JournalNeurosurgery
Volume51
Issue number5
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

Keywords

  • Cranial base
  • Meningioma
  • Necrotizing granuloma
  • Neurosarcoidosis
  • Sphenoid wing

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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  • Cite this

    Tobias, S., Prayson, R. A., Lee, J. H., Friedman, A. H., Samdani, A., Brem, H., Rock, J. P., & Pollock, B. E. (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