PMC5075611_01
One can see clockwise the MR images of the tumour on T1-weighted, on T1 with contrast, and on T2-weighted images.
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fig1
The patient had undergone a cerebral MRI scan (Figure 1) that showed a 3 cm maximal diameter isointense lesion centred in the region of the right cavernous sinus on T1-weighted images.
The CT angiography shows that the tumour is adjacent to the wall of the right internal carotid artery.
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fig2
The mass appeared adjacent to the wall of the carotid artery (Figure 2); the CT venous phase (Figure 3) showed that the cavernous sinus was compressed and medialized by the tumour rather than invaded by it.
The CT venous phase shows that the cavernous sinus is compressed and medialized by the tumour rather than invaded by it.
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fig3
The mass appeared adjacent to the wall of the carotid artery (Figure 2); the CT venous phase (Figure 3) showed that the cavernous sinus was compressed and medialized by the tumour rather than invaded by it.
Anatomical diagram of the cavernous sinus: 1: hypophysis, 2: internal carotid artery, 3: 6th CN, 4: meningeal (outer) layer, 5: cavernous sinus, 6: sphenoid sinus, 7: endosteal (inner) layer, 8: V1, 9: V2, 10: 4th CN, 11: 3rd CN, and 12: the outer layer at the diaphragma sellae. The endosteal layer is marked in green, while the meningeal layer is marked in yellow.
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fig4
On the basis of the images and of the clinical history of the patient it was theorized that the tumour might have developed in the virtual space existing between the dura and the inner membrane of the lateral wall of the cavernous sinus (Figure 4).
In (a), the arrow indicates the bulging of the lateral wall of the cavernous sinus caused by the tumour; in (b), the arrow points to the appearance of the tumour after the incision of the dura.
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fig5
The dura of the wall of the cavernous sinus was incised where it protruded the most, thus exposing a well-capsulized grey-yellowish tumour (Figure 5).
An MRI scan performed 5 months after surgery shows complete removal of the tumour.
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fig6
An MRI scan (Figure 6) performed 5 months after surgery showed complete removal of the tumour.