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Meningioma of the tentorium with extension through the incisura tentorii

CLINICAL HISTORY:
This 58-year old woman, complains of progressive gait instability, disturbances of memory and urinary incontinence. Recently she notes diminished vision.

NEUROLOGICAL EXAMINATION shows a positive Romberg test and broad-based gait. Dysdiadochokinesia is noted. Coordination tests are bilaterally abnormal.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): A hyperdense , focally calcified midline mass is seen (arrowheads), probably located infratentorially. Supratentorial hydrocephalus, due to compression of the aquaduct or the posterior third ventricle is noted.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): Moderate and homogeneous enhancement is noted. Notice enhancement of the tentorium (arrow), confirming the infratentorial location of the mass.

MRI:
a) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGES 3 AND 4): The mass is hypointense, with some focal signal drop out (arrowheads), due to calcification. Posterior compression on the brainstem is seen.

b) TRANSAXIAL (IMAGES 5 AND 6) AND SAGITTAL (IMAGES 7 AND 8) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: The mass shows homogeneous and moderate enhancement and is broadly implanted on the tentorium (arrowheads). Above the tent, the normal signal void in the straight sinus is noted. The tumor markedly compresses the brainstem and the colliculi, with total obliteration of the aquaduct and downward displacement of the fourth ventricle (arrow). The tumor extends through the incisura (small arrows).

ANGIOGRAPHY: Lateral projection of the selective internal carotid artery and superselective ophthalmic artery injection (IMAGES 9 AND 10). The tumor is supplied by a recurrent meningeal branch of the ophthalmic artery and is highly vascular.

RADIOLOGICAL DIAGNOSIS is meningioma of the tentorium based on the calcification, the broad insertion on the tentorium, the extraaxial location and the intense homogeneous enhancement.

SURGICAL FINDINGS: Surgery was performed via suboccipital craniotomy. The mass was well circumscribed and highly vascular. The tumor was inserted over the entire anteroposterior length of the tentorium and was firmly attached to the free edge of the tent, with extension above the incisura. Compression of the colliculi and brainstem was confirmed. Total resection was performed.

ANATOMOPATHOLOGY shows endotheliomatous meningioma.

Searvh also:
Meningioma

 

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Fig. 1

Meningioma of the tentorium with extension through the incisura tentorii, Fig. 1
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 2
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 3
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 4
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 5
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 6
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 7
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 8
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 9
Meningioma of the tentorium with extension through the incisura tentorii, Fig. 10