Wk 4, Case 2 - Review

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Report

Patient History
47 year-old Female skull base wand protocol for diplopia

Findings
Skin fiducials are present. There is avidly enhancing left cavernous sinus mass with a dural tail along the left tentorial leaflet and middle cranial fossa. This enters the sella and compresses the pituitary stalk, pituitary gland. Extension within the right cavernous sinus and abutment of the right clinoid/supraclinoid internal carotid artery is present. This mass distorts the left lateral aspect of the suprasellar cistern and circumferentially encases and narrows the left C3, C4 and C5 portions of the internal carotid arteries. The majority of the left supraclinoid internal carotid artery is encased by the cavernous mass. This mass surrounds 90 to 180 degrees of the left M1 segment of the middle cerebral artery. Tumor extends tp the middle cranial fossa, compressing the left uncus and protrudes within the left prepontine cistern with mass effect upon the left anterolateral pons. The mass obliterates Meckel's cave on the left with compression of the distal cisternal left 5th cranial nerve. No mass extension within the left foramen ovale. There is mass effect with superior displacement and encasement of the distal left cisternal 3rd cranial nerve. Tumor bulging through Dorello's canal on the left with encasement of the left 6th cranial nerve. No involvement of the left posterior cerebral artery. There is abutment of the optic chiasm and left optic nerve with tumor along the undersurface of the left optic nerve to the orbital apex. No tumor extension within the left orbital apex. Tumor involves the left aspect of the clivus and left anterior clinoid process.

Impressions
Avidly enhancing left cavernous sinus/Meckel's cave mass with multilateral dural extension consistent with meningioma.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 4, Case 2 - Review