Clinical question: History of left temporal/sphenoid meningioma status post XRT. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.The examination redemonstrates an expansile enhancing mass arising from the left greater wing of the sphenoid consistent with a previous known meningioma. There is extension of tumor into the left anterior middle cranial fossa similar to prior exam and with a meniscal adjacent left anterior temporal lobe encephalomalacia/edema. The tumor extends into the apex of the left orbit with enhancement and subtle thickening of the left lateral rectus muscle and without convincing evidence of interval change.There is inferior extension of tumor into the left pterygopalatine fossa edema. Several measurements of tumor in various axis demonstrate no convincing evidence of change. The largest component of tumor measures 21.6-mm in transverse axis at the level of the skull base which is identical to prior exam. The left anterior middle cranial component the tumor measuring approximately 21 mm in length is also identical to prior study.Stable expected for chronic postoperative changes of left pterional craniotomy since prior exam. Similar to prior exam there are a few tiny foci of flair hyperintensity in the periventricular and subcortical white matter bilateral cerebral hemispheres which likely representing chronic small vessel ischemic strokes. Possibility of possible overlapping of postradiation change cannot be entirely excluded.There is no detectable or new foci of parenchymal signal abnormality or abnormal parenchymal/leptomeningeal enhancement.
1.No evidence of an acute or new finding since prior study.2.Stable left greater wing of the sphenoid meningioma in size and extent and pattern of enhancement since prior study. Tumor involves the left greater wing of the sphenoid, left anterior aspect of the middle cranial fossa, left orbital apex and left skull base and pterygopalatine fossa similar to prior exam.3.Findings suggestive of mild chronic nonhemorrhagic ischemic strokes.