PMC7451176_01
Gadolinium T1-weighted magnetic resonance imaging images showing postcontrast enhancement of five meningiomas, <3 cm each, located at the right cerebral middle fossa, at the border of the right tentorium, at the torcula, at the middle third of the superior sagittal sinus , and at the left Sylvian fissure (a). T2-weighted sequences documented typical bilateral enlargement of optic nerve sheath, related to intracranial hypertension; of notice, ventricles were not enlarged, conversely, they present slit-like aspect (b). T2-weighted Turbo spin echo brain magnetic resonance imaging sequences showing normal representation of cisterns and sulci that rule out the hypothesis of pseudotumor cerebri (c).
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F1
The patient underwent in-depth investigation that documented cerebral meningiomatosis, characterized by 5 meningiomas, <3 cm each, located at the right cerebral middle fossa, at the border of the right tentorium, at the torcula, at the middle third of the superior sagittal sinus (SSS), and at the left Sylvian fissure; a T2-weighted brain MRI sequence documented a typical bilateral enlargement of optic nerve sheath, related to intracranial hypertension; of notice, ventricles were not enlarged, but they presented slit-like aspect [Figure 1].
Brain magnetic resonance imaging with cerebrospinal fluid flowmetry revealed an irregular pattern at the level of the Sylvian aqueduct, resulting in its reduced diameter due to compression by the right tentorial meningioma
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F2
Considering that the tentorial meningioma was compressing the Sylvian aqueduct, an MRI with cerebrospinal fluid (CSF) flowmetry was performed revealing an irregular pattern at the level of Sylvian aqueduct [Figure 2]; cerebral MR venography showed normal venous flow at the level of the SSS, due to the fact that the meningiomas were of little size and in T1-weighted gadolinium-enhanced images, there was no invasion of the SSS.
Postoperative head computed tomography scan showed correct catheter positioning and stability of the ventricular diameters.
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F3
The postoperative period was uneventful, a postoperative brain computed tomography scan [Figure 3] showed correct catheter positioning and stability of the ventricular diameters.