Interactive Transcript
0:00
So as I've been pontificating here
0:02
about syndromic meningioma,
0:05
you've been looking at the more
0:07
important practical things,
0:08
and what's the thing that strikes you that's
0:10
most important regarding this meningioma?
0:13
So the most important thing regarding this meningioma
0:15
is its relationship to the surrounding structures.
0:18
In this case,
0:18
it actually encases the left internal carotid artery.
0:22
I'm going to put an arrow on the carotid artery,
0:23
and you can see how it's narrowed right there.
0:26
On the other side, not so much.
0:28
And then I'm going to take that away,
0:29
and then I'm going to actually draw over the tumor
0:32
so you can see the tumor very nicely.
0:33
The tumor is this gray structure right here.
0:36
And what do you think about the amount of
0:39
edema that the central tumor elicits?
0:41
Do you think there's any brain or parenchymal vasogenic edema?
0:44
So that's the interesting thing about this case,
0:45
is there is no surrounding vasogenic edema.
0:48
As he pulls down the FLAIR sequence
0:50
on the far right panel,
0:54
the tumor is relatively large,
0:55
and there is no surrounding vasogenic edema.
0:58
Yeah, when we were discussing this offline,
1:00
I mentioned to Dr. Laser, I thought,
1:02
there is a little bit of vasogenic
1:04
edema right behind here,
1:05
but I was simply looking at a cleft of CSF that
1:08
was displaced, not real vasogenic edema.
1:11
And you pointed out correctly that, hey,
1:13
you got to go look at the FLAIR to see if there really is any.
1:15
Now, on the flip side,
1:16
if there was a lot of vasogenic edema,
1:18
that wouldn't bother me so much.
1:20
Although I will say that the skull-based ones,
1:23
even though they're fibrovascular and they grow in
1:25
a very serpiginous, difficult way to remove,
1:29
you don't see as much vasogenic edema
1:31
with the ones that are down low,
1:32
where you see big-time vasogenic edema are the
1:35
ones in the convexity and the upper falx.
1:37
But again, you and I discussed before,
1:40
lots of young residents and attendings will see these
1:43
big meningiomas with tremendous vasogenic edema,
1:45
and they go after glioblastoma multiforme,
1:48
ignoring the tenet of, is it intraaxial or extraaxial?
1:52
So don't be misled.
1:53
Big meningiomas can have plenty of vasogenic edema.
1:58
I think we're ready to move on to another one.
1:59
Let's do it.
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