Meningioma extending into the cavernous sinus

Case contributed by Dr Bruno Di Muzio

Presentation

Not available.

Patient Data

Age: 50 years
Gender: Female

There is a sellar and suprasellar mass invading the right cavernous sinus and extending into the medial aspect of the right middle cranial fossa and to the thickened right tentorium cerebelli. The lesion extends to the right orbital apex, however there is no intraorbital involvement. The lesion also extends to the margins of foramen rotundum and ovale without evidence of definite V2 or V3 involvement. The mass is stable compared to the previous MRI (not shown), however has increased compared to the oldest available study (3 years ago).

The lesion encases the cavernous segment of the right internal carotid artery, which is significantly narrowed but demonstrates a preserved flow void. There has been progressive narrowing of the right cavernous internal carotid artery since the MRI from 3 years ago. There is also invasion of the left cavernous sinus (to a lesser extent than the right), without significant narrowing of the cavernous segment of the left internal carotid artery. The mass is isointense to grey matter on T1, slightly hyperintense on T2 and demonstrates vivid, slightly heterogeneous contrast enhancement. Blooming within the mass likely represents calcification.

The infundibulum is mildly deviated to the left. The optic chiasm is not compressed. A normal pituitary gland is not identified as separate from the mass. There is associated mild mass effect on the right mesial temporal lobe and right side of the pons. The basilar artery is small in calibre however is not encased by the mass.

7 mm focus of susceptibility artefact in the right parietal lobe at the grey-white matter junction is again demonstrated. Punctate focus of FLAIR hyperintensity in the left frontal lobe is unchanged and likely due to chronic small vessel ischaemia. No diffusion restriction. No hydrocephalus.

Conclusion:

Sellar/suprasellar mass invading bilateral cavernous sinuses (to a greater degree on the right) most likely represents a meningioma. This is stable in size compared to the previous MRI.

Case Discussion

This case illustrates a solid skull base tumour invading the cavernous sinus bilaterally. Despite the benign histological features of a meningioma, this location is a problem for surgical resection, which usually results in severe neurological deficits and just partial debulking. Stereotactic radiosurgery or fractionated stereotactic radiotherapy are treatment options for those patients with inoperable and symptomatic tumours like this one.

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Case information

rID: 37285
Case created: 2nd Jun 2015
Last edited: 15th Feb 2016
Tag: rmh
Inclusion in quiz mode: Included

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