case_images: PMC10559378_01
case_images: T1 weighted image with contrast magnetic resonance imaging (MRI) (a) axial, (b) coronal, and (c) sagittal planes revealed a left sided frontal mass, with a heterogeneously enhancing central content along with a peripherally enhancing component. The lesion measured 48 x 60 x 55 mm in the rostro-caudal, dorso-ventral, and latero-lateral directions, respectively, and seems to be external to the brain parenchyma. It extends upward into the left lateral ventricle, exerting mass effect, and displacing it medially. The heterogeneously enhancing center is compatible with a flow void sign, which, when associated with an internal enhancement, is suggestive of partial lumen patency, in the context of a giant internal carotid artery (ICA) aneurysm. The peripheral enhancement is consistent with the aneurysmatic arterial wall. (d) Axial, (e) coronal, and (f) sagittal planes revealed a right sided, homogeneously enhancing solid extra axial mass, suggestive of a meningioma, arising from the lateral outer tentorial ring and extending downward to the infratentorial space and medially indenting the pons and right.
case_images: SNI-14-317-g001.jpg
case_images: PMC10559378_01_SNI-14-317-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging (MRI) revealed two lesions: a supratentorial paraclinoid lesion that occupied the left frontotemporal region and a right infratentorial solid extra axial mass, suggestive of a tentorial meningioma [Figures 1 and 2].
case_images: Macroscopic findings. (a-c) An ovoid, extra-axial lesion was found with an adequate dissection plane firmly adhered to blood vessels at the level of the operculoinsular region of the Sylvian fissure. The lesion capsule was opened to access the contents, revealing solid, yellowish material suggestive of cholesterol deposits. Zones of old bleeding were found peripherally to the lesion. During the dissection of the peripheral blood vessel capsule, a solution of continuity of the left internal carotid artery communicating segment occurred, which was suggestive of an aneurysmal neck at that level. The resected lesion was suggestive of a thrombosed giant aneurysm, which ruptured the aneurysmal neck during dissection, despite being repaired with suture there was a high risk of thrombosis and/or extensive cerebral infarction.
case_images: SNI-14-317-g002.jpg
case_images: PMC10559378_01_SNI-14-317-g002.jpg
case_images: F2
case_images: Magnetic resonance imaging (MRI) revealed two lesions: a supratentorial paraclinoid lesion that occupied the left frontotemporal region and a right infratentorial solid extra axial mass, suggestive of a tentorial meningioma [Figures 1 and 2].