Meningioma - cavernous sinus

Case contributed by Dr Ammar Haouimi

Presentation

Right fourth nerve palsy.

Patient Data

Age: 35 years
Gender: Female
MRI

The MRI sequences demonstrate a right parasellar mass (27 x 20 x 17 mm) centered on the cavernous sinus, displaying an isosignal to the cortical grey matter on T1/T2, and FLAIR with vivid homogeneous enhancement on postcontrast sequences and hyperostosis of the anterior clinoid. There is encasement with the reduced caliber of the ipsilateral internal carotid artery. Medially there is an extension to the sellar region with a shifted pituitary stalk to the left. Posteriorly a partial filling of the  Meckel cave with mild thickening and enhancement of the prepontine dura are noted.

Cavum septum pellucidum is incidentally noted.

Case Discussion

MRI features are most consistent with meningioma of the cavernous sinus.

On imaging, there is a wide differential (see cavernous sinus mass).

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