PMC5991277_01
Upper row shows the pre-operative magnetic resonance imaging (MRI) showing four meningiomas: (1) a suprasellar meningioma, (2) a small frontal midline meningioma in front of the suprasellar meningioma, (3) a right-sided midline frontal convexity meningioma, and a (4) large right-sided frontal convexity meningioma. Lower row shows the 1-week postoperative MRI where meningiomas (1), (2), and (4) have been totally removed. Numbers 1-4 refer to meningiomas as mentioned in the main text
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F1
The patient was sent to neuroimaging and magnetic resonance imaging (MRI) showed a total of four meningiomas: (1) a suprasellar meningioma compressing the left optic nerve and chiasm causing the patient's symptoms, (2) a small frontobasal midline meningioma at the level of cribriform plate, (3) a small frontal right-sided convexity meningioma, and another (4) large frontal right-sided convexity meningioma [Figure 1, upper row]. Postoperative MRI showed complete removal of (1) suprasellar meningioma, (2) frontobasal midline meningioma, and (4) frontal right-sided convexity meningioma [Figure 1, lower row].
Upper row shows the 1-year postoperative magnetic resonance imaging (MRI) with no regrowth of the operated meningiomas (1, 2, 4) and no major growth of the (3) right-sided midline frontal convexity meningioma. Middle row shows the 2-year postoperative MRI with some growth of (3) right-sided midline frontal convexity meningioma and growth of a (5) new meningioma in the suprasellar space. Lower row shows the 4-year postoperative MRI showing some growth of the unoperated (3) right-sided midline frontal convexity meningioma and major growth of the (5) new suprasellar meningioma. Numbers 1-4 refer to meningiomas as mentioned in the main text
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F2
The patient was followed with sequential imaging, and 1 year after surgery a repeat MRI showed no regrowth of resected meningiomas but slight growth of small frontal right-sided midline convexity meningioma (3) that had been left untouched [Figure 2, upper row]. The patient was managed expectantly and HRT was continued unchanged [Figure 2, middle row]. Four years after operation, another MRI showed significant growth of (5) suprasellar meningioma and (3) of the previous unoperated right-sided midline frontal convexity meningioma [Figure 2, lower row].
PMC5991277_02
Upper row shows the pre-operative magnetic resonance imaging (MRI) revealing a total of four meningiomas: (1) left-sided sinus cavernous, (2) left-sided frontal convexity, (3) left-sided temporal convexity, and (4) right-sided tentorial. Lower row showing immediate postoperative MRI revealing subtotal resection of the (1) sinus cavernous meningioma and total removal of the two left-sided convexity meningiomas (2, 3)
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F3
MRI was obtained that revealed four meningiomas: (1) in the left-sided sinus cavernous, (2) over the left-sided frontal convexity, (3) over the left-sided temporal convexity, and (4) right-sided tentorial [Figure 3, upper row]. Moreover, the patient had undergone a contrast-enhanced head CT 10 years before the current presentation due to transient vertigo and the respective CT was assessed as completely normal. Postoperative MRI showed complete removal of convexity meningiomas and a reduction in the size of sinus cavernous meningioma [Figure 3, lower row].