Gradual onset of headache, over several months. In addition, unsteadiness has been noticed recently to be more severe.
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A large, left sided, exctra-axial, petroclival homogeneously enhancing mass lesion is seen, which measures (4.7X3.7X5.0 cm). The left ambient cistern is effaced by the lesion, which also invades the left Meckel's cave and compresses the left side of brain stem. Besides, there is evidence of the left cavernous sinus invasion along with encasement of the ipsilateral internal carotid artery (not invaded- its signal void is preserved). There is, also, significant contralateral displacement of the basilar artery. There is significant compression on the brain stem with contralateral right-ward displacement. No gross evidence of hydrocephalus. Dural tail sign is also seen.
Given the above mentioned appearances, petroclival meningioma is highly likely.
2 case question available
The case was proven to be meningioma (WHO 1) on histopathology.
Petroclival meningiomas are tumours that originate from the upper two third of the clivus at the petroclival junction, medial to the fifth cranial nerve. Clinical presentation usually characterised by its insidious onset, with features caused by cranial nerve involvement (fifth and eighth cranial nerves being most commonly affected), mass effect on cerebellum, brain stem compression, as well as raised intracranial pressure.
- 1. Marcus L. Ware. Petroclival and Upper Clival Meningiomas I: An Overview of Surgical Approaches. 403-414. doi:10.1007/978-1-84628-784-8_44
- 2. Diluna ML, Bulsara KR. Surgery for petroclival meningiomas: a comprehensive review of outcomes in the skull base surgery era. Skull Base. 2010;20 (05): 337-42. doi:10.1055/s-0030-1253581 - Free text at pubmed - Pubmed citation