Presentation
Headache, seizures and visual disturbance.
Patient Data
A large extra-axial space occupying lesion is noted resting on the right lesser wing of the sphenoid bone and extending to both anterior and middle cranial fossae exerting mass effect with effacement of the related sulci and gyri as well as effacement of the right lateral ventricle.
It encases the right cavernous sinus, the supra-clinoid portion of the right internal carotid artery and its bifurcation as well as M1 segment of right MCA and A1 segment of the right ACA. The mass wraps around the right anterior clinoid process and shows intra-sellar extension indenting the pituitary gland. It shows a wide dural base. Still no definite intra-orbital extension.
Subfalcine midline shift is noted reaching 16 mm. Mass effect with indentation of the right cerebral peduncle also noted. It also extends to the right side of the prepontine cistern, mildly indenting the right side of the pons and the basilar artery.
The lesion shows T1 intermediate and T2 intermediate to low signals with evident enhancement and mild restricted diffusion. The mass is measuring 6 X 6.5 X 6 cm in AP, SS and CC dimensions respectively.
Case Discussion
The radiological features are in keeping with a large sphenoid wing meningioma with a considerable mass effect. As meningioma is a slowly growing tumor, it can present with large sizes at presentation.
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