History of meningioma, preoperative planning for resection. Examination is obtained for operative planning and intraoperative navigation. There is a large avidly enhancing mass along the right frontal convexity measuring proximately 8.5 x 7.5 x 4.3 cm. Mass is also seen extending along the anterior falx with relatively small component to the left of the midline. There is surrounding edema with downward mass effect on the right greater than left lateral ventricles and the corpus callosum. Mass effect also results in leftward midline shift of 1.5 centimeters at the level of the cingulate gyrus. No uncal herniation. The anterior and mid superior sagittal sinus are severely attenuated. Bilateral distal anterior cerebral artery branches are leftward displaced. No hydrocephalus.There is thickening of the right frontal calvarium compatible with hyper ostosis. There is mild associated enhancement of the right frontal calvarium including the overlying scalp. No frank osseous destruction is seen.
1. Examination for operative planning demonstrating large right-sided meningioma extending along the the right frontal convexity and the anterior falx. 2. Severe attenuation of the anterior mid aspect of the superior sagittal sinus. There is downward mass effect and 15 -mm leftward midline shift. 3. Sclerosis and thickening of the right frontal calvarium which is likely reactive. There is mild associated enhancement of the calvarium and overlying scalp raising a small possibility of calvarial invasion. No osseous destruction is seen. 