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Meningioma of the cavernous sinus, totally calcified

CLINICAL HISTORY:
This 25-year old man is known to have a parasellar meningioma, proven by biopsy 10 years ago. Since then slowly progressive left exophtalmos has developed. The patient is blind on the left side. There is ptosis of the left eyelid.

CLINICAL NEUROLOGICAL EXAMINATION shows blindness on the left side. The left optic nerve appears atrophic and pale. There is ptosis and miosis on the left side.

CONTRAST-ENHANCED CT (IMAGE 1): Within the left cavernous sinus a densely calcified mass is seen (arrowheads). The lesion extends to the left orbit through a considerably widened optic canal and superior orbital fissure (arrow). There is some enhancement along the free edge of the tentorium. Severe exophtalmos is noted.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGES 2 AND 3): The mass (arrowheads) is seen in the left parasellar region, extending to the left orbit and posteriorly to the petrous bone. Due to the calcifications the signal is inhomogeneously and markedly hypointense.

b) CORONAL T1-WEIGHTED (600/15/1) SPIN-ECHO SEQUENCE (IMAGES 4 AND 5): The tumor now is more isointense to grey matter, but with diffuse hypointensities due to calcification. Notice the erosion of the lateral wall of the sella turcica and the sphenoid sinus (white arrow). The internal carotid artery (arrowhead) is displaced inwards. There is displacement and compression of the left temporal lobe.

c) TRANSAXIAL (IMAGES 6 AND 7) AND CORONAL (IMAGES 8 AND 9) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is definite but inhomogeneous enhancement of the tumor. Notice again the erosion of the lateral wall of the left cavernous sinus and sphenoid sinus. The lesion extends through the optic canal and the superior orbital fissure into the left orbit (arrow), causing severe exophtalmos. There is some posterior extension along the apex of the petrous bone (arrowheads).

RADIOLOGICAL DIAGNOSIS is calcified meningioma of the cavernous sinus.

ANATOMOPATHOLOGY: The biopsy performed 10 years earlier showed meningioma.

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Fig. 1

Meningioma of the cavernous sinus, totally calcified, Fig. 1
Meningioma of the cavernous sinus, totally calcified, Fig. 2
Meningioma of the cavernous sinus, totally calcified, Fig. 3
Meningioma of the cavernous sinus, totally calcified, Fig. 4
Meningioma of the cavernous sinus, totally calcified, Fig. 5
Meningioma of the cavernous sinus, totally calcified, Fig. 6
Meningioma of the cavernous sinus, totally calcified, Fig. 7
Meningioma of the cavernous sinus, totally calcified, Fig. 8
Meningioma of the cavernous sinus, totally calcified, Fig. 9