 Please note, the postcontrast 3-D T1 images were inadvertently not acquired. There is unchanged extra-axial dural based mass along the greater right sphenoid wing with enhancement measuring 44 ML x 36 CC x 42 AP mm on series 1201 image 14 and series 1101 image 12. There is central heterogeneity. The predominant portion of the mass is centered along the skull base of the right middle cranial fossa, although some portion extends along the anterior clinoid process into the right anterior cranial fossa. The mass intimately abuts the right cavernous sinus and the right supraclinoid internal carotid artery, as well as the right M1 segment causing superior deviation of the right M1 segment which appears to be draping over the mass, as noted on the prior exams. There are also unchanged serpiginous linear flow voids posteriorly along the border of the mass best seen on axial T2 images, which probably represent displaced vascular structures which are outlined due to presence of edema.The mass shows T1 isointense and mild T1 hyperintense signal relative to white matter with mild increased DWI signal. As noted on the prior exam, there may be mild thickening of the right anterior clinoid process and greater sphenoid wing suggesting hyperostosis. There is a thin cleft of CSF signal separating this lesion from the adjacent temporal lobe which is again compressed with persistent leftward uncal herniation causing compression and leftward deviation of the mid brain, unchanged. There is vasogenic edema within the right temporal lobe tracking superiorly into the right parietal lobe and basal ganglia. There is persistent mass effect with near effacement of the right lateral ventricle, and midline shift to the left of 9 mm without change. There is an enlarged left lateral ventricle again seen with a prominent left occipital horn, suggesting entrapment. The third and fourth ventricles are unchanged in caliber and not dilated. There is no acute infarct.
1. Stable enhancing extra-axial mass centered at the right greater sphenoid wing and right anterior clinoid process causing extensive right temporal lobe vasogenic edema, mass effect with midline shift, right uncal herniation, effacement of the right lateral ventricle, as well as stable dilation of the left lateral ventricle suggesting entrapment. This most likely represents a meningioma.2. Mass abuts the right cavernous sinus, and is in close proximity with the right distal internal carotid artery and M1 segment.