PMC3307242_01
(a) FLAIR image showing a hyperintense lesion beside the brain stem. (b) Three months later, the lesion enlarged and eroded into the midbrain, with peritumoral edema. (c, d) Contrast-enhanced MR imaging showing a homogeneously enhanced mass with a dural tail (arrow)
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F1
Magnetic resonance (MR) imaging revealed a mass lesion located beside the left cerebral peduncle; this mass appeared isointense on T1-weighted imaging (T1WI) and hyperintense on fluid-attenuated inversion recovery (FLAIR) imaging [Figure 1a]. After 3 months, the lesion had enlarged with obvious perifocal edema in the cerebral peduncle [Figure 1b]. Contrast-enhanced MR imaging showed a homogeneously enhanced lesion that had eroded into the midbrain [Figure 1c and d].
Lateral views of the left external carotid artery angiogram, in (a) late arterial and (b) venous phases, showing filling of the lesion from the periphery to the center with a sustained and persistent blush from the middle meningeal artery
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F2
Cerebral angiography revealed that the blood supply originated from a branch of the middle meningeal artery and also revealed contrast pooling in the venous phase [Figure 2a and b].
Intraoperative view: A multilobulated, mulberry-like lesion attached to the cerebellar tentorium, which is a typical macroscopic feature of CMs
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F3
The lesion appeared as a multilobulated, mulberry-like mass located on the tentorium [Figure 3].
Postoperative axial MRI showing size reduction and central necrosis in the lesion (a) with decreased perifocal edema (b). (c) Three months later, the lesion appeared with homogeneous enhancement. (d) Two months after gamma knife radiosurgery, the lesion shrank remarkably
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F4
MR imaging 1 week after the operation showed central necrosis of the lesion concomitant with mass reduction and diminution of the perifocal edema in the midbrain [Figure 4a and b]. However, 3 months later, the lesion recurred with homogeneous enhancement [Figure 4c]. The lesion shrank remarkably in size by 2 months after the treatment [Figure 4d].