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Meningioma of the tentorium with supra- and infratentorial extension

CLINICAL HISTORY:
This 37-year old woman has a five year history of partial complex seizures, without generalization. Now there is an increase in the frequency of epileptic episodes.

NEUROLOGICAL EXAMINATION is normal.

CT:
CONTRAST-ENHANCED SCAN (IMAGES 1 AND 2): Presence of two rounded enhancing tumor nodules (arrows), one in the left posterior fossa and the other in the left temporo-occipital region. The latter lesion is clearly in contact with the tentorium.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): The cerebellar lesion is hard to differentiate from the brain.

b) TRANSAXIAL T1-WEIGHTED (680/20/1) SPIN-ECHO SEQUENCE (IMAGE 4): Again the lesion (arrowheads) is isointense but with a small surrounding rim.

c) TRANSAXIAL (IMAGE 5), CORONAL (IMAGE 6) AND SAGITTAL (IMAGE 7) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is homogeneous enhancement of the lesion. Both the supra- and infratentorial component are broadly implanted on the tentorium with evidence of a small dural tail (arrow).

RADIOLOGICAL DIAGNOSIS is meningioma of the tentorium with extension above and below the tentorium.

SURGICAL FINDINGS: Surgery was performed via suboccipital craniotomy. The infratentorial part of the tumor was inserted on the tentorium, up to the transaxial sinus and compresses the cerebellum. Via a dural incision above the transaxial sinus, the supratentorial part was reached. A small layer of tumor, strongly adherent to the vein of Labbé, had to be left in place.

ANATOMOPATHOLOGY shows meningotheliomatous meningioma.

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Meningioma

 

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Fig. 1

Meningioma of the tentorium with supra- and infratentorial extension, Fig. 1
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 2
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 3
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 4
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 5
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 6
Meningioma of the tentorium with supra- and infratentorial extension, Fig. 7