Clinical question: History of meningioma status post XRT. Please evaluate/computer. Signs and symptoms: Right blurry vision. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.There is revisualization of a meningioma within the right cavernous sinus with resultant expansion of the cavernous sinus, extension into the sella, minimal extension into the right Meckel's cave, right orbital apex and right paramedian subfrontal spread along the planum sphenoidale without convincing evidence of any significant interval change since prior study from 9-20 3-14. The largest transverse diameter of meningioma in the cavernous sinus and sella measures at 31 mm which compared to prior exam demonstrate no appreciable interval change. Minute extension of tumor into the right orbital apex to the right of optic nerve also remains identical to prior study. This finding is best appreciated on axial T2 series 701 image 12 axial post enhanced series 1001 image 12. If further more precise assessment of this finding is clinically desired dedicated pre- and post enhanced MRI of orbits would be helpful.The tumor similar to prior exam minimally bulges superiorly into the basal cistern however without mass effect on the chiasm. Minute spread of tumor into the prepontine cistern along the dorsal aspect of the dorsum sella remains also similar to prior exam. Similar to prior exam there is no convincing evidence of decreased caliber of right cavernous carotid which is encased by tumor.Similar to prior exam there is a tiny developmental venous anomaly in the right rectus jugular venous and is best appreciated on axial post enhanced series 1001 images 14 and 15 and sagittal reformatted post enhanced series 1/1/2002 on images 39 through 46.Multiple tiny foci of FLAIR hyperintensity in the periventricular and subcortical white matter of bilateral cerebral hemispheres demonstrate no significant change and highly suggestive of mild chronic small vessel ischemic strokes without change. Ventricular system remains within normal and maintained midline. Unremarkable images through the calvarium, soft tissues of the scalp, mastoid air cells, middle ear cavities and visualized paranasal sinuses.
1.No acute intracranial process and stable findings suggestive of mild chronic small vessel ischemic strokes.2.Stable size, morphology, signal intensity and homogeneous pattern of enhancement of a meningioma within the right cavernous sinus and sella turcica with minimal expansion superiorly into the basal cistern, minimally into the right orbital apex and minimally in the right Meckel's cave and right paramedian subfrontal as detailed above.3.Revisualization of a tiny right paramedian inferior frontal developmental venous anomaly.