Diagnosis: Benign neoplasm of cerebral meningesClinical question: h/o right atypical meningoma s/p resection; now with recurrenceSigns and Symptoms: preop planning There is a large extra-axial mass which extends from the right cerebellar medullary angle cistern, the right cerebellopontine angle cistern over the right petrous bone into the right cavernous sinus and into the right half of the suprasellar cistern, the right sella into the sphenoid sinus through the right foramen rotundum and right foramen ovale into the infratemporal fossa. In the posterior fossa it extends into the right internal auditory canal and through the right hypoglossal canal and surrounds the right carotid artery at the C1 and C2 levels. It appears to also extend into the petrous portion of the right carotid canal. It displaces the right cerebellar hemisphere posteriorly and displaces the brainstem towards the left and distorts it. It compresses the right temporal lobe infiltrates the entire right cavernous sinus and pituitary fossa and encases the right internal carotid artery. It displaces the right optic nerve superiorly and medially and displaces the optic tract and partially surrounds the right optic nerve along its cisternal portion and enters into the right orbital apex. It also insinuates itself into the right sylvian fissure. It surrounds some of the right middle cerebral artery vasculature. It extends into the right ambient cistern suspected to be encasing the nerves and vasculature in that location. It is associated with midline shift shift of the third ventricle approximately 8 mm to the left of midlineThere is associated signal change in the right temporal lobe and the right cerebellar hemisphere.The flow-void of the right jugular vein is not identified.There is opacification of the right mastoid air cells.
1.There is a large extra-axial mass which surrounds the right temporal bone fills much of the right middle cranial fossa and extends through the neural foramina and the posterior fossa on the right side as well as the right skull base, extends into the cavernous sinus and surrounds the right internal carotid artery along its distal cervical, petrous segment and cavernous and supraclinoid segments. It also extends into the right orbital apex and displaces and partially surrounds the right optic nerve. It is also insinuates itself into the right sylvian fissure and surrounds some of the middle cerebral artery branches. It compresses the right temporal lobe and compresses the insula and deep gray nuclei and is associated with midline shift. It also occupies the pituitary fossa some of the foramina that are involved include the right jugular foramen, right hypoglossal canal, right internal auditory canal, right foramen rotundum, right foramen ovale, right carotid canal, right orbital apex. Extracranially extends into the right infratemporal fossa and the right carotid space as well as the right orbit and the sphenoid sinus. It also peeled 6 to infiltrate the right skull base and the right temporal bone. The right jugular vein may be occluded2.This is a limited exam for stereotactic guidance