Meningiomas - multiple posterior fossa
Right sided hearing loss.
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Four enhancing extra-dural masses are again identified in the posterior fossa, compatible with meningiomata. Three abut the petrous temporal bones (two on the right, one on the left) and the fourth projects inferiorly from the right side of the tentorium cerebelli. The smaller of the two right petrous masses bulges into and largely covers the right internal acoustic meatus, likely resulting in compression of the traversing facial, vestibular and cochlear nerves.
FLAIR hyperintensities scattered within the periventricular and subcortical white matter likely reflect chronic small vessel ischemia, of a degree commonly seen at this age.
Some patients, even in the absence of prior radiation or NF2 have a predilection for developing meningiomata. In this case one must assess the left lesion just adjacent to the IAC carefully as were this to represent an acoustic schwannoma then the diagnosis of NF2 would be suspected (unusual in this age group).
Meningioma confirmed histologically.