Left cavernous sinus meningioma. Assess extent of disease for radiation treatment planning. There is an extra-axial, mildly lobulated mass in the region of the left petroclinoid ligament and cavernous sinus. The mass is relatively isointense to gray matter on both T1 and T2 and shows intense, heterogeneous contrast enhancement. The mass invades the left cavernous sinus and circumferentially encases and mildly narrows the cavernous segment of the left internal carotid artery. It also extends medially to mildly compress the pituitary gland. It does not extend into the optic canal and has only minimal superior extension into the suprasellar cistern which does not affect the optic chiasm. Left Meckel's cave is displaced and deformed. The lesion abuts the left anterolateral surface of the pons without significantly deformity.The mass is associated with fairly extensive dural thickening which extends and tapers and fashion along the floor of the middle cranial fossa, including the foramen ovale, and reaching anteriorly to the left greater wing of the sphenoid. It also extends posteriorly along the tentorium cerebelli. The mass itself measures in the axial plane 4.1 cm x 1.9 cm (as on series #2401, image #40). This, however, does not include the extensive dural tail described above.Compared to the previous examination from February 2015, the mass has slightly grown in size. Previously it did measure approximately 2.4 cm x 2.0 cm (series #301, image #7).The brain is otherwise normal. The ventricles are normal in size. There is minimal mucosal thickening in the anterior ethmoid sinuses without fluid. The paranasal sinuses are clear otherwise. The mastoid air cells are clear as well.Orbits:The orbits and the orbital structures are normal. As discussed above, the left petroclival meningioma reaches close to the optic canal but does not involve it.
1.Left petroclival meningioma with involvement of the cavernous sinus and sella as described above. The mass is also associated with extensive dural thickening extending some distance from the epicenter of the mass which might be reactive or tumoral. The mass has slightly increased in size since the previous examination of February 2015.2.There is no direct impingement on the optic nerve or chiasm.