Clinical question: Evaluate growth of meningioma. Signs and symptoms: Recurrent meningioma. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Examination demonstrates a new falcine meningioma in the posterior frontal and parietal region since prior exam. The tumor expands bilaterally from the falx and measures at 42 x 26 mm in transaxial dimensions and 34 mm in craniocaudad axis and reaches the inferior edge of the falx. Additionally there is a second new meningioma in the high convexity right posterior parietal and along the right lateral aspect of falx measuring approximately at 15 x 25 x 29 mm in size. This mass is immediately anterior to the edge of the craniotomy flap from prior surgery.Small loculated foci of dural based enhancement along the most posterior left lateral aspect of the falx suspected of residual meningioma on prior exam demonstrates significant interval increase size. This finding on prior exam measured approximately at 7 x 12 mm however on current study the tumor has dramatically increased in size and measures at least at 60 x 28 mm in transaxial dimensions. This finding extends anteriorly and projects into the quadrigeminal plate cistern and posterior 3rd ventricle. This tumor is inseparable from the straight sinus and the vein of Galen which are highly suspected to be encased by tumor. This tumor also minimally extends along the superior medial aspect of bilateral tentorial leaves (L>R). Constellation of above new findings results in new bilateral hemispheric vasogenic edema in bilateral posterior frontal and parietal lobes.Moderately enlarged supratentorial ventricular system with maintained midline demonstrate no significant interval change.
1.Significant interval progression of disease since prior study.2.Large new meningiomas along the falx as detailed/measurement above.3.Significant interval increase small foci of residual meningioma in the left occipital region with anterior extension into the quadrigeminal plate cistern, posterior third ventricle and with encasement of the straight sinus and the vein of Galien as detailed/measurement above.4.Interval new foci of vasogenic edema secondary to an above-mentioned tumors in bilateral posterior frontal and parietal lobes.5.Stable moderately enlarged supratentorial ventricular system with maintained midline.