Trigeminal schwannoma

Case contributed by Melbourne Uni Radiology Masters
Diagnosis almost certain

Presentation

Headaches.

Patient Data

Age: 56-year-old
Gender: Female

MRI Brain

mri

A vividly-enhancing mildly heterogenous (predominantly T1 hypointense / mildly T2 hyperintense) ovoid mass is centred within the left Meckle's cave, indenting the left cavernous sinus, sella and petrous apex.It is uncertain whether this represents a trigeminal Schwannoma or meningioma, with the former slightly favoured.

The left cavernous ICA is mildly effaced/displaced, with no overt compression.

Note is made of a mildly expanded "empty sella".

The left MCA bifurcation appears mildly dilated and follow-up MRA could be used to exclude the presence of an aneurysm in this location.

The remainder of the study is unremarkable.

Case Discussion

The Imaging findings are those of a trigeminal schwannoma.

Possible Meckel's cave tumours include: 

  • trigeminal schwannoma: most common, ~33% of cases
  • meningioma
  • pituitary macroadenoma
  • metastases
  • epidermoid cyst
  • lipoma
  • base of skull tumours

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