 Redemonstrated a small enhancing lesion measuring involving the left cavernous sinus which enters somewhat into the sella displacing normal pituitary as well as the pituitary stalk rightward. It abuts the cavernous left internal carotid artery without narrowing. Laterally it demonstrates a broad-based dural attachment. Although there is no associated osseous hyperostosis, there is some osseous remodeling however no aggressive lytic features. Given the constellation of these findings including comparison to the prior studies dating back to 2005, the most likely consideration is meningioma.Foci of hypodensity are seen in the periventricular white matter without mass effect which correlates with previous MRI demonstrated chronic small vessel ischemic disease. The ventricles are unchanged in size or shape without evidence of obstruction or hydrocephalus. There are no other masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is no other abnormal enhancement within the brain.
Evidence for meningioma involving the left cavernous sinus extending into the sella as well as laterally without evidence of cavernous carotid narrowing. Given differences in technique, there is been no significant change since the comparison MRI dated 3/3/2012. This lesion was present on the comparison CT from 2005, and although it has demonstrated increase in size since that study, given the long 7 year interval, a benign process such as meningioma is the most likely etiology.