Petrous apex meningioma with extracranial spread

Case contributed by Bálint Botz
Diagnosis certain


Sustained a fall. IC bleeding?

Patient Data

Age: 80 years
Gender: Female
  • no sign of IC bleeding or bony trauma
  • Incidentally the structure of the right petrous apex appears inhomogeneous, with an adjacent 20 mm sclerotic lesion
  • widened right foramen ovale, expanded by the calcific mass

Findings suggestive of meningioma, planned MRI recommended. 

  • an about 27 x 25 mm, inhomogeneous low signal extraaxial mass is visible adjacent to the petrous apex

  • The lesion widens the foramen ovale, and extends into the pterygoid space greatest craniocaudal dimension reaching 40 mm

  • inhomogeneous enhancement post contrast

  • note resultant ipsilateral muscle atrophy, best seen in the depicted masseter, likely due to secondary denervation

  • mild chronic small vessel ichemic changes and état criblé appearance of the basal ganglia

  • mild vertebrobasilar dolichoectasia

Case Discussion

Meningiomas can demonstrate extracranial spread via the skull base foramina, thus careful assessment of the structures is necessary if the lesion is situated close to them. 

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