55 years old female with right lower cranial nerve palsy, right trigeminal neuralgia and chronic headache.
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- a right petro-clival homogenously enhancing mass lesion is seen. The lesion measures about 4.5 X 4.5 X 3.5 cm in its main axial and CC diameters. The lesion causes effacement of the right ambient cistern with significant right sided brain stem compression and invasion of the right Meckel’s cave and the right cavernous sinus as well as encasement of the cavernous segment of the right ICA with preserved signal void. The lesion displaces the basilar artery as well.
- normal ventricular system.
- small bilateral corona radiata and centrum semiovale demyelinating foci of high T2 / FLAIR signals. No restricted diffusion.
- no intra-axial mass lesion.
- normal cortical sulci.
- incidenatally noted is right maxillary sinusitis.
Petroclival meningioma arises in the upper two thirds of the clivus at the petroclival junction medial to the fifth cranial nerve. These tumors displace the brain stem and the basilar artery to the opposite side. Petroclival meningiomas are surgically challenging tumors due to the proximity to cranial nerves, major blood vessels, and the brainstem with considerably high postoperative morbidity and mortality. Patients usually present with insidious onset of headache, lower cranial neuropathy with unilateral hearing loss or facial sensory disturbances may be the most frequently encountered and in severe cases, trigeminal neuralgia. Brainstem and cerebellar compression signs e.g. gait disturbance are not uncommon. Gamma Knife surgery of petro-clival meningiomas is the treatment of choice.
- 1. Van Havenbergh T, Carvalho G, Tatagiba M et-al. Natural history of petroclival meningiomas. Neurosurgery. 2003;52 (1): 55-62. Pubmed citation
- 2. Nanda A, Javalkar V, Banerjee AD. Petroclival meningiomas: study on outcomes, complications and recurrence rates. J. Neurosurg. 2011;114 (5): 1268-77. doi:10.3171/2010.11.JNS10326 - Pubmed citation