Specific Imaging Findings

Perisellar meningiomas originate from the dural walls of the cavernous sinus, the sellar diaphragm, or within the Meckel's cave, with the epicenter characteristically at the edge or outside the sella turcica, commonly suprasellar. The mass is typically hyperdense on CT and the tumor enhances avidly and homogeneously with contrast on CT and MRI. Similar to meningiomas in other locations, they are usually T1 isointense and slightly T2 hypointense to the cortex, of homogenous appearance. Sclerotic hyperostotic changes of the adjacent bone may be present. Like in other intracranial locations, they frequently demonstrate a tapered dural extension, known as the “dural tail” sign. Within the cavernous sinus meningiomas encase the internal carotid artery, typically significantly narrowing its lumen. Bilateral cavernous sinus involvement is occasionally found.

Pertinent Clinical Information

Meningiomas may be clinically silent and represent incidental findings, or can be the cause of different signs and symptoms depending on their size and location, due to compression of adjacent structures. The common presenting symptoms are ophthalmoplegia, visual disturbances, and trigeminal neuralgia. Hormonal disbalances, either increased (usually prolactin) or decreased pituitary hormone levels may also be encountered. The clinical and laboratory findings may simulate those of primary pituitary pathological processes, and imaging plays an essential role in the characterization of these lesions. Suprasellar meningiomas can cause visual field defects and obstructive hydrocephalus; retroclival meningiomas can cause dysfunction of the cranial nerves and brainstem compression; cavernous sinus invasion usually presents with ophthalmoplegia.