Cavernous sinus meningioma

Case contributed by Dr Craig Hacking

Presentation

Fall with headstrike. Unequal pupils, L>R, sluggish.

Patient Data

Age: 65 years
Gender: Male
Modality: CT

No acute surface collection, haemorrhage or infarction. No mass effect, space occupying lesion or midline shift. The ventricles and basal cisterns are patent and normal for age. Grey - white matter differentiation is preserved.

There is an ill-defined slightly hypodense mass lesion measuring 20 x 13 mm centred in the left cavernous sinuses extending posteriorly into the pre-pontine cistern and laterally abutting the medial aspect of the left temporal lobe. It appears separate to the pituitary gland. The sella is not enlarged. There is no enlargement of the left superior orbital vein to suggest cavernous sinus thrombosis.

No acute bony abnormality. No orbital pathology detected. Mild mucosal thickening of the right maxillary sinus and sphenoid sinus. The mastoid air cells are clear.

Conclusion

  • No haemorrhage or other acute intracranial pathology evident.
  • Left cavernous sinus mass lesion, which may be responsible for the unequal pupils. Further investigation with post contrast CT advised in the first instance. Differential diagnosis includes a meningioma, giant ICA aneurysm or schwannoma related to the nerves of the cavernous sinus.
Modality: CT

Soft tissue mass measuring 2 x 2.5 x 2 cm centred on the left cavernous sinus, wrapping around the posterior clinoid process and dorsum sellae shows that the contrast enhancement. No further enhancing lesion identified elsewhere in the brain. The left intracranial internal carotid artery is not significantly narrowed by the mass. No intracranial aneurysm.

Aortic arch anatomy is conventional. Bilateral carotid bulb calcified plaque results in less than 15% stenosis on the left and approximately 30% stenosis on the right. The vertebral arteries are normal in appearance.

Extensive mucosal thickening of the right maxillary antrum again demonstrated.

Conclusion

The contrast enhancing mass centred on the left cavernous sinus is most in keeping with a meningioma.

Case Discussion

The meningioma was though to be compressing of the cranial nerves passing though the cavernous sinus and hence the cause of the pupillary signs.

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Case Information

rID: 37473
Case created: 10th Jun 2015
Last edited: 15th Feb 2016
Inclusion in quiz mode: Included

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