Clinical question: Preoperative planning for craniotomy/tumor resection. Signs and symptoms: Preop planning. Pre- and post enhanced Stealth brain MRI:Examination demonstrates multiple dural based well-demarcated enhancing tumors bilaterally in supratentorial space. The largest lesion is in right high convexity anterior frontal measuring approximately at 33 x 26 x 30 mm in size. There is buckling of the adjacent brain parenchyma without detectable edema. There is underlying bony thickening. Findings consistent with a meningioma.Right mid frontal dural based meningioma along the inner table of right frontal bone measure at 20 x 18 x 14 mm in size.A right high convexity parietal dura is enhancing meningioma measuring at 25 x 22 x 19 mm size.A right posterior frontal falcine meningioma demonstrates slight extension through the falx to the left. This lesion measures 19 x 27 x 23 mm in size. Subtle associated mass effect without parenchymal edema is noted. A tiny left posterior parietal high convexity meningioma measuring approximately 9 x 6 mm is present.A tiny left posterior parietal occipital junction dural based meningioma measuring 8 mm at the base and 4 mm in height.A left occipital falcine meningioma measures 10 x 5 mm in size is noted.A tiny right sided meningioma arising from the greater ring of the sphenoid and measuring at 7 x 4 mm size.An enhancing intracanalicular schwannoma on the left measuring 7.4 mm in length and 4 mm in AP axis is present. The finding minimally bulges into the left cerebellopontine angle cistern and does not reach the depth of the left IAC.None of the lesions demonstrate any appreciable edema. Ventricular systems remain within normal size and without deviation of midline. Multiple foci of T2 hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres without enhancement are noted. Although nonspecific the findings could however represent mild chronic small vessel ischemic strokes.
1.Multiple bilateral supratentorial dural based meningiomas as detailed/measured above. The larger lesions demonstrate regional mass effect on the adjacent parenchyma however without evidence of parenchymal edema or midline shift. There is no significant change since prior exam from 4-13-152.A left intracanalicular schwannoma measuring at 7.4 x 4 mm as detailed.3.Findings suggestive of mild chronic small vessel ischemic strokes.