Dffuse dural thickening and enhancement with multiple areas of nodular thickening and durally based masses compatible with extensive meningiomatosis.
There is a bulky disease involving the falx cerebrum, the largest component at the vertex measuring 3.8 x 2.6 x 3.9 cm, and that the left posterior parafalcine region measuring 3 x 2.1 x 5.1 cm. Tumour extensively invades and occludes the superior sagittal sinus. A non-dominant right transverse sinus and sigmoid sinus are patent.
Further bulky meningioma is centred on an expanded left cavernous sinus, bulging laterally into the middle cranial fossa, medially to involve the sella, inferiorly into the left sphenoid sinus, and posteriorly into Meckel's cave. Abnormal enhancing tumour extends through the right superior and inferior orbital fissures to involve the orbital apex and cause mild left proptosis. There is also involvement of pterygopalatine fossa, and tumour extending into the left foramen ovale. Cavernous carotid flow-voids are maintained.
Of note, there bilateral vestibular schwannomas.
Conclusion: Extensive meningiomatosis, with bulky disease along the falx with superior sagittal sinus invasion/occlusion, and a large left cavernous sinus meningioma involving skull base foramina in the orbital apex.