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Meningioma of the tentorium, case 1

CLINICAL HISTORY:
This 63-year old woman complains of a few years of generalized headaches. For the past three years she has noted progressive difficulties with equilibrium and intermittent nausea.

NEUROLOGICAL EXAMINATION shows gait instability and left dysmetria and dysdiadochokinesia.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): A huge, densily calcified mass is seen in the left paramedial region of the posterior fossa.

b) CONTRAST-ENHANCED SCAN IN THE TRANSAXIAL (IMAGE 2) AND CORONAL (IMAGE 3) DIRECTION: Intense enhancement of the lesion is noted. On the coronal slice (image 3) the lesion appears to be in broad contact with the tentorium (arrowheads).

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 4): The tumor is markedly hypointense with focal areas of signal drop-out due to calcification (arrow).

b) TRANSAXIAL T1-WEIGHTED (460/15/1) SPIN-ECHO SEQUENCE (IMAGE 5): The tumor is isointense to grey matter. Substantial displacement of the brainstem (arrow) and compression of the cerebellum are appreciated.

c) TRANSAXIAL (IMAGE 6 AND 7) AND CORONAL (IMAGES 8 AND 9) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The tumor shows homogeneous and intense enhancement, except for the calcified center. The mass is in broad contact with the tentorium (arrowheads) and shows some supratentorial extension through the tentorial hiatus (arrow). Enhancement of the adjacent tentorial dura mater is noted (small arrow).

RADIOLOGICAL DIAGNOSIS is calcified meningioma of the tentorium. The diagnosis is based on the broad insertion on the tentorium, the calcification and the intense enhancement.

SURGICAL FINDINGS: At surgery, the tumor was very hard, densily calcified and was broadly inserted on the tentorium on the midline and in the left paramedial region. The tumor extended above the incisura. A complete resection was achieved.

ANATOMOPATHOLOGY was consistent with fibromatous meningioma.

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Fig. 1

Meningioma of the tentorium, case 1, Fig. 1
Meningioma of the tentorium, case 1, Fig. 2
Meningioma of the tentorium, case 1, Fig. 3
Meningioma of the tentorium, case 1, Fig. 4
Meningioma of the tentorium, case 1, Fig. 5
Meningioma of the tentorium, case 1, Fig. 6
Meningioma of the tentorium, case 1, Fig. 7
Meningioma of the tentorium, case 1, Fig. 8
Meningioma of the tentorium, case 1, Fig. 9