Skull base meningioma with infratemporal extension

Case contributed by James Sheldon
Diagnosis almost certain

Patient Data

Age: 50 years
Gender: Female

Large destructive skull base meningioma (biopsy proven) demonstrated. The tumor extends into the ethmoid and sphenoid sinuses, left maxillary sinus, nasal cavity, pituitary fossa, left petrous apex and clivus. There is involvement of the left orbital apex with mild proptosis of the left globe and extension into the pterygopalatine fossa. Mass effect on the left mesial temporal lobe and inferior frontal lobe. The mass extends into the prepontine cistern. The tumor encases the intracranial left ICA and extends into the middle cranial fossa . There is extension of the tumor into the suprahyoid aspect of the neck.

Case Discussion

Meningiomas are the most common extra-axial tumors of the central nervous system and account for 14-20% of all intracranial neoplasms . They are a non-glial neoplasm that originates from the arachnoid cap cells of the meninges.

Many small meningiomas are found incidentally and are entirely asymptomatic. Larger tumors, or those with adjacent edema or abutting particularly sensitive structures can present with a variety of symptoms.

Meningiomas are located anywhere that meninges are found, and in some places where only rest cells are presumed to be located. Locations include:

  • 85-90% supratentorial
  • 5-10% infratentorial
  • < 5% miscellaneous intracranial
  • <1% "extra dural"

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