Left temporal mass. Right hemiparesis. History of left cavernous sinus meningoma; status post radiation in the mid 1990s at Ingles. BRAIN MRI:The heterogeneous mass involving the left middle cranial fossa is probably extra-axial but invaginating or invading into the left temporal lobe from inferiorly. The mass shows intense but heterogeneous contrast enhancement, especially in its anterior part. It contains blood products, especially in its posterior part with associated susceptibility artifact and peripheral deep T2-hypointensity. This component within the left middle fossa measures maximally 6.1 cm anteroposteriorly and 3.1 cm craniocaudally (image #22 of series #16). In transverse, it measures 3.8 cm as on image #22 of series #10. T1 shortening as well as small fluid levels are noted associated with the left temporal intraparenchymal hemorrhage. There is relatively remarkable hyperintense T2 signal that extends to involve the left temporal, parietal and posterior frontal white-matter, including the external and extreme capsules as well as the posterior limb of the internal capsule. The T2 signal abnormality is compatible with vasogenic edema, although component of this may represent chronic post treatment change. This is also associated with mass-effect compressing the left lateral ventricle and causing mild midline shift.There is a separate tiny focus of susceptibility effect in the left temporal lobe posterior to this mass which may reflect blood product or calcification. There is minimal blood in the occipital horn of the left lateral ventricle, probably as an extension from the hemorrhage associated with a mass in the left middle cranial fossa.The mass is associated with an infiltrative contrast-enhancing mass that involves the left cavernous sinus, left petroclival ligament, sella turcica and also extends along the dorsal aspect of the clivus. Osseous changes including sclerosis/hyperostosis are better appreciated on recent CT. The mass also reaches very close to the left foramen ovale though not definitively through it. Involvement of the left cavernous sinus is associated with encasement and narrowing of the cavernous segment of the left internal carotid artery. There is also involvement of the left Meckel's cave with encasement of the left trigeminal nerve. The left optic canal is involved but there is no definite optic nerve atrophy or abnormal contrast enhancement. There is also no intraorbital extension. There is involvement of the left superior and inferior orbital fissures as well as foramen rotundum. Posteriorly there is also minimal mass-effect on the left anterolateral aspect of the inferior mid brain/upper pons.The remainder of the brain is notable for nonspecific scattered T2-hyperintense foci involving the frontoparietal white-matter. There is also mild periventricular T2-hyperintensity. There is no associated brain parenchymal diffusion restriction. There is no separate contrast enhancing brain lesion. Besides the mass-effect closed by the above-described mass, there is overall mild expansion of the CSF-containing spaces, reflecting mild global brain volume loss.There is a small retention cyst in the inferior aspect of the right maxillary sinus. Other paranasal sinuses show trace mucosal thickening. There is no gross orbital abnormality besides the above described involvement of the left optic canal. Sclerotic focus involving the left lateral mass of C1 is better seen on CT.CRANIAL MRA:Accounting for the above described mild narrowing of the cavernous (C2) segment in addition to the distal petrous (C2 and C3) segments of the left internal carotid artery by the mass, there is displacement of the left middle cerebral artery sylvian branches by the mass-effect. Otherwise, there is no significant stenosis or asymmetry of flow-related signal of the major intracranial arteries. There is no aneurysm. Of note, the right vertebral artery is dominant.CRANIAL MRV:Left cavernous sinus is invaded as mentioned above. The dural venous sinuses are otherwise patent. The internal cerebral veins are patent as well.
1.Overall findings are consistent with a large left petroclival meningioma with invasion of the cavernous sinus as well as suggestion of intraparenchymal invasion into the left temporal lobe. There is evidence of recent intraparenchymal hemorrhage within the left temporal lobe likely related to the tumor with extensive surrounding vasogenic edema. Minimal intraventricular blood products are also noted.2.There is extensive mass effect on the left trigeminal nerve and its branches. Tumor extends to left orbital apex including involvement of the optic canal. There is also minimal mass effect on the left aspect of the pons.3.Besides mild compression of the left internal carotid artery and displacement of the sylvian branches of the left middle cerebral artery, the intracranial MRA is unremarkable.4.MR venogram shows patent dural venous sinuses, aside from the left cavernous sinus mentioned above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.