Recurrent cerebellopontine angle meningioma

Case contributed by Dr Bruno Di Muzio

Presentation

Left hearing loss and vertigo.

Patient Data

Age: 35 years
Gender: Female

MRI Brain

Modality: MRI

There is a solid and well-defined mass in the left cerebellopontine angle, isointense on T1 and hyperintense on T2 compared to the cerebral grey matter, showing homogenous contrast enhancement and the dural tail sign. The mass covers the left IAM, however there is no sign on its enlargement. 

MICROSCOPIC DESCRIPTION: The sections show a moderately cellular meningioma with infiltration into the attached dura. The tumour comprises whorls. The tumour cells have ovoid nuclei with no significant nuclear pleomorphism. Mitoses are inconspicuous. There is no necrosis. No brain parenchyma is included in the biopsy. There is no atypical or malignant change.

DIAGNOSIS: Meningioma (WHO Grade I).

CT Brain (Post-tumour resection)

Modality: CT

Left retrosigmoid approach to the excision of the left cerebellopontine meningioma noted. No definite filling defect in the left transverse or sigmoid sinus.

Appearance on the post-operative scans is more suggestive of a small amount of haemorrhage within the extra-axial space at the surgical site rather than sinus thrombosis. A 3mm filling defect at the confluence of the vein of Galen, the straight sinus and the inferior sagittal sinus probably does represent a small thrombus.

Remaining imaged sinuses, jugular bulbs and imaged internal jugular veins opacify uniformly.

Conclusion: Small (3mm) venous sinus thrombosis.​

MRI Brain - Follow-up 3 years later.

Modality: MRI

 

Image quality is degraded by motion artifact.

Allowing for this the appearance of the left petroclival residual/recurrent meningioma is unchanged. It measures a maximal depth of 6.5mm at the level of the internal acoustic meatus. The tumor is seen to extend along the clivus over the tentorium into the middle cranial fossa. The cavernous sinus is not involved.Elsewhere there are no intra or extra-axial collections or mass lesions.

No diffusion restriction identified.

Conclusion: No change in appearance of left petroclival meningioma.​

MRI Brain - Follow-up 4 years later.

Modality: MRI

 

Residual/recurrent left cerebellopontine angle meningioma has not appreciably increased in size since the MRI six months ago, measuring 10 mm in maximum thickness. The lesion extends over the undersurface of the left tentorium to involve Meckel's cave.

High T2/FLAIR signal within the adjacent left middle cerebellar peduncle has further increased in extent, now extending into the pons.

No further lesions are identified. The remainder of the imaged brain is unremarkable. A mucocoele is again noted within the right maxillary sinus.

Conclusion: The left cerebellar pontine angle residual/recurrent meningioma appears stable since the most recent study, with slight increase since last year. High T2/FLAIR signal abnormality within the adjacent middle cerebral peduncle has increased, now extending into the pons.

Case Discussion

This case demonstrates a histologically proven left cerebellopontine angle meningioma resected around four years ago and which has been increasing progressively since then.   

PlayAdd to Share

Case Information

rID: 40575
Case created: 27th Oct 2015
Last edited: 15th Feb 2016
Tag: rmh
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.