Presentation
Behavioral changes and seizure.
Patient Data
There is a mildly enhancing extraaxial mass seen in the right temporal lobe measuring about 3 x 3 x 2.5 cm (AP,RL,CC) with calcifications and extensive surrounding vasogenic edema in the temporoparietal lobes. It is causing significant mass effect and midline shift of about 1 cm, with effacement of the basilar cisterns and medial herniation of the medial aspect of the right temporal lobe raising the suspicion of uncal herniation as well. In addition to sclerosis of the greater wing of right sphenoid bone, for neurosurgical evaluation. It is abutting the M1 segment of right MCA.
A well-defined rounded extra-axial lesion is noted at the level of right greater sphenoid wing measuring about 3.3 x 3.7 x 3.6 cm in AP, TV and CC dimensions respectively which appears mainly isointense to the grey matter on T1WI and T2WI showing multiple foci of blooming artefact on SWI, homogenous enhancement and enhancing dural tail on postcontrast images.
The lesion causes significant mass effect on the ipsilateral right lateral ventricle, right side of mid brain obliterating the right crural cistern and narrowing the interpeduncular cistern with ipsilateral uncal herniation as well as vasogenic edema in the right parietotemporal lobes and shifting the midline for about 7 mm suggesting subfalcine herniation.
The lesion abuts the M1 segment of right MCA and displaces the right MCA superiorly.
No restriction diffusion.
Case Discussion
Features are suggestive of a partially calcified right sphenoid wing meningioma. 15-20% of meningiomas are found at the sphenoid ridge.
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