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.