Meningioma

A large, well-defined left parafalcine dural-based frontoparietal convexity extra-axial mass with a wide dural tail and CSF cleft, causes a mass effect on the underlying brain tissue, resulting in the effacement of cortical sulci and ipsilateral lateral ventricle with a midline shift of about 5 mm, measuring about 7.4 x 5 x 4.7 cm in the AP, TS, and CC dimensions, respectively.

It shows hypo-intense T1, heterogenous T2 signal, and mild diffusion restriction, with solid internal postcontrast enhancement.

No evidence of bone destruction. No acute infarction.

Multiple bilateral T2/FLAIR hyperintensities were seen involving the periventricular and subcortical white matter without diffusion restriction or mass effect suggesting mild small vessel disease.

Old lacunar infarction is noted in the right frontal lobe.

Capacious CSF spaces and basal cisterns compatible with the patient's age.

Pathology report:

Biopsy: consistent with meningioma, WHO grade I.

No features of atypia or anaplasia were seen in the levels examined in this material.

No brain tissue was identified in this material.

A craniotomy was done and an excision of the lesion.

After one year, a brain MRI with contrast was done for follow-up and showed:

Evidence of left parietal craniotomy with post-surgical changes and some old blood products.

There is lobulated, well-defined left parafalcine dural-based frontoparietal extra-axial mass, which appears isointense to grey matter on T1, hyperintense on T2/FLAIR, and mild diffusion restriction measuring about 5.5 x 2.4 x 2 cm in the AP, TS, and CC dimensions, respectively.

The lesion shows heterogenous enhancement with dural tail enhancement on postcontrast images.

There is a significant decrease in the size of the known left parietal meningioma and its mass effect.

Significant interval improvement regarding the mass effect with no midline shift in comparison to the previous study one year ago.