Meningioma. Headache. Assess for change. The 2 cm lobulated dural based, intensely contrast enhancing mass in the posterior fossa at midline has not changed. It abuts and probably invades into the torcular herophili and the adjacent parts of the straight and left transverse sinuses. The remainder of these sinuses remain patent. The mass abuts but does not invade into the right transverse sinus or the superior sagittal sinus. Of note, the superior sagittal sinus predominantly drains through the right transverse sinus. The overlying skull is unremarkable. The adjacent cerebellar vermis and medial aspect of the right cerebral hemisphere are unremarkable, apart from mild mass-effect. Flow voids and corresponding contrast-enhancing vessels on the surface of the mass probably represent displaced superficial vessels.There is no other dural based mass. There is no contrast enhancing brain lesion. Tiny central CSF intensity with surrounding rim of T2/FLAIR hyperintensity inferior to the left putamen may represent chronic infarct. There is no acute infarct. Foci of T2 FLAIR hyperintensity in the cerebral white-matter are nonspecific but may reflect chronic microvascular ischemia. The ventricles are mildly dilated reflecting mild brain volume loss. There is no midline shift or brain herniation. Major intracranial arterial flow voids are preserved.There is moderate anterior ethmoid mucosal thickening. There is mild mucosal thickening in the remaining paranasal sinuses. The orbits are unremarkable.
1.The posterior fossa meningioma which seems to involve the junction between the left transverse and the straight sinuses (torcular herophili) has not significantly changed when allowing for differences in technique since October 2015. Patency of these sinuses is probably better assessed by MR venography, if clinically warranted. The other dural sinuses are patent.2.Mild cerebral white-matter changes of chronic microvascular ischemia. Small left putaminal chronic infarct.