Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit

1

57/F

Headache, diplopia, ptosis

Right: III nerve palsy, left V1 hypoesthesia

Circumscribed, isodense, homogenous contrast enhancement

Circumscribed, T1-hypo- and T2-hyperintense

Meningioma

Vascular meningioma

2

45/M

Headache, diplopia, ptosis

Fifth nerve palsy

Poorly circumscribed, hyperdense, homogenous contrast enhancement

ND

Cavernous hemangioma

Cavernous angioma

3

42/F

Headache, ocular pain, visual loss

third and sixth nerve palsy left side

ND

Poorly circumscribed, hypointense lesion with central hyperintensity on T1, homogenous contrast enhancement

Cavernous hemangioma

Cavernous angioma

4

73/M

Memory loss, headache, giddiness, visual loss

Short-term memory loss

ND

Circumscribed, hyperintense on T2

Metastatic adenocarcinoma

5

5/M

Diplopia, visual loss, sensory disturbances, headache

Left sixth nerve palsy

ND

Circumscribed, hyperintense lesion, homogenous contrast enhancement

Cavernous hemangioma

Cavernous angioma

6

25/F

Pain, sensory disturbances

ND

Ill circumscribed, enhancing irregularly

ND

Aspergilloma

Aspergilloma

7

53/F

Pain, ptosis, visual loss

Total ophthalmoplegia. second–fourth and sixth nerve palsy left

Ill circumscribed, enhancing irregularly

ND

Meningioma

Fungal sinusitis, aspergillosis

8

17/F

Headache, amenorrhea, visual loss

Right eye, total loss of vision; left eye, temporal hemianopia

Isodense, homogeneous enhancement, calcified

Iso on T1, hyperintense, homogenous contrast enhancement

Cavernous hemangioma

Cavernous hemangioma

9

32/F

Ptosis, visual loss

Left third nerve palsy with pupillary sparing

ND

Hypointense on T1 and hyperintense on T2, homogenous contrast enhancement

Meningioma

Cavernous hemangioma

10

49/F

Headache, giddiness

Left third and sixth nerve palsy

ND

Hypo on T1, hyper on T2 lesion, homogenous contrast enhancement

Schwannoma

Cavernous hemangioma

11

20/F

Headache, ptosis, visual loss

Conscious, oriented, left ptosis with total ophthalmoplegia, palsy

Well circumscribed, homogeneous enhancement

Isointense on T1and hyperintense on T2, homogenous contrast enhancement

Cavernous hemangioma

Cavernous hemangioma

12

28/F

Headache, ptosis, facial dystonia

Left third, fourth, and sixth nerve palsy, fifth motor sensory paresis

Isodense, Homogeneous enhancement

Hypointense on T1, hyperintense on T2 erosion of petrous, homogenous contrast enhancement

Cavernous hemangioma

Cavernous hemangioma

13

24/M

Sensorimotor trigeminal neuropathy, slowly progressive

NA

NA

NA

NA

Aspergilloma

14

49/F

Headache

NA

NA

NA

NA

Aspergilloma

15

19/F

Headache

Left third, fourth, and sixth nerve palsy

NA

NA

NA

Vascular schwannoma

16

21/M

Double vision

Left sixth nerve palsy

NA

NA

NA

Cavernous angioma

17

22/M

NA

NA

NA

Right parasellar lesion, extending into sella, pituitary made out separately, grossly hyperintense on T2WI and FLAIR, isointense on T1WI, homogenous postcontrast enhancement with central few areas of nonenhancement. ICA is not narrowed.

Cavernous hemangioma. Right side

DD: microcytic meningioma

cavernous angioma

18

22/F

Left ptosis, left diplopia, headache, drowsiness

ND

Left parasellar lesion with suprasellar extension. Large grossly hyperintense lesion on T2WI and FLAIR images, with central hypointense areas. Isointense on T1WI, heterogenous exuberant postcontrast enhancement. No obvious blooming areas on SWI. Left cavernous and supraclinoid ICA is stretched with no obvious narrowing

Left cavernous hemangioma

Cavernous angioma

19

48/M

Diplopia, drooping of eyelid and vision loss in left eye

Left third–fifth nerve palsy. Left V1/V2 sensory deficit

ND

Left parasellar lesion, heterogeneously hyperintense on T2WI and FLAIR (not so hyperintense) with appearance of septations within it, hypointense on T1WI with heterogenous enhancement with more non enhancing areas. Extension into foramen rotundum noted along left maxillary nerve. No areas of blooming noted. ICA not involved

Left trigeminal schwannoma

DD: meningioma

Low-grade chondrosarcoma

20

20/M

Diplopia and vision loss in right eye

ND

Right parasellar lesion, heterogeneously hyperintense on T2WI and FLAIR (few hypointense areas are also seen), hypointense on T1WI and showing heterogenous post-contrast enhancement. (Not so hyperintense as was seen in hemangioma). Right cavernous ICA is stretched and narrowed.

Right-sided meningioma

Schwannoma

21

58/F

Headache, photophobia, left eyelid drooping

left third, fourth, and sixth palsy, left V1 hyperesthesia

ND

Left sided parasellar lesion with sellar extension. Hyperintense on T2WI and FLAIR, hypointense on T1WI with exuberant postcontrast enhancement. No blooming areas noted. ICA is stretched without narrowing

Incidentally, anterior falcine meningioma noted

Left cavernous hemangioma

DD: meningioma in view of presence of one more meningioma

Hemangioma

22

40/F

Right facial paresthesia, numbness eye movement restriction and visual disturbance

–

ND

Right parasellar lesion with sellar extension. Uniformly hyperintense on T2WI and FLAIR Images with exuberant postcontrast enhancement. No blooming in SWI. Stretching of right ICA noted

Right cavernous hemangioma

Hemangioma

23

55/M

Pain, tingling, loss of sensation in left face

left proptosis, left second–fifth and seventh nerve involvement

ND

Limited films. Left parasellar lesion with orbital extension appearing hypointense on T2WI and FLIAR images and isointense on T1WI showing uniform enhancement with orbital extension also

Meningioma

Poorly differentiated adenocarcinoma

24

25/F

NA

NA

NA

Left parasellar lesion. Hypointense on T2WI and FLAIR images, isointense on T1WI with uniform postcontrast enhancement. Dural tail also noted

meningioma

Mets carcinoma

25

48/F

Facial paresthesia

Right-sided third nerve paralysis

ND

Right large parasellar lesion with suprasellar extension. Grossly hyperintense on T2WI and FLAIR, hypointense on T1WI no blooming on SWI images, ICA is stretched, heterogenous postcontrast enhancement with few non enhancing hypointense areas within it

Cavernous hemangioma

Cavernous hemangioma

26

28/M

Headache, left periorbital pain, left eye diplopia × year

–

ND

Left parasellar lesion, heterogenous signal intensity on T2WI and FLAIR images, grossly hyperintense cystic areas with solid isointense areas on T2WI and FLAIR and heterogenous postcontrast enhancement. ICA is stretched and narrowed. Blooming areas are seen on SWI images

Left fifth nerve schwannoma.

DD meningioma

Schwannoma

27

24/F

Card NA

Cavernous sinus hemangioma (nonfunctioning)

ND

Left large parasellar lesion with suprasellar extension. Having both hypointense and hyperintense areas on T1WI and FLAIR images. Uniformly hypointense on T1WI. Showing exuberant post-contrast enhancement (both areas)

Cavernous hemangioma

Cavernous hemangioma

28

46/F

Headache, left facial pain × 5 month, left eyelid drooping × 1 year,

Left MCA infarct

ND

Left parasellar lesion with suprasellar and posterior fossa extension. Appearing heterogeneously hyperdense on CT scan, hyperintense on T2WI and FLAIR images, hypointense on T1WI, heterogenous postcontrast enhancement. Narrowing of the ICA noted with stretching. No bony destruction seen. No blooming on SWI images

Meningioma

DD: fungal lesion

Aspergillus

29

56/M

Right eyelid drooping × 10 month, diplopia × 2 months

Only CT images are available and appear hypodense with presence of calcifications

Right parasellar lesion with sellar and Meckel's cave extension. Appearing hyperintense on T2WI and FLAIR images with septations like appearance within it. Showing blooming on SWI images. Gross postcontrast enhancement is seen. It is hypointense on T1WI

Right trigeminal schwannoma

Low-grade chondrosarcoma

30

65 Y/M

drooping of left eyelid, left eye loss of vision for 2 weeks, one episode of seizure, left V1 paresthesia

–

ND

Left parasellar lesion with suprasellar extension. Large lesion with homogenous hyperintensity on T2WI and FLAIR images, hyperdense on CT scan and Isointense on T1WI, showing exuberant postcontrast enhancement with few non enhancing hypointense areas. No blooming on SWI images. Facilitated diffusion. ICA is stretched and narrowed

Left cavernous hemangioma

Cavernous angioma

31

30/F

Left eye deviation, left eye vision loss

Left eyelid drooping for 3 months, left third, fourth, and sixth nerve palsy, left cavernous sinus lesion with hemangioma

It is hypodense on CT with punctate calcification

Left parasellar lesion having extension into the suprasellar region, left Meckel's cave and along the fifth nerve into the left prepontine cistern heterogeneously hyperintense on T2WI and partially inverting on FLAIR images, hypointense on T1WI and showing mild heterogenous postcontrast enhancement. Blooming foci are seen on SWI images

Left trigeminal schwannoma. Possibly cystic

DD: meningioma

Chordoma

32

56/F

Right eye ptosis, diplopia

–

ND

Right parasellar lesion with posterior fossa extension. Moderately hyperintense on T2WI and FLAIR images with homogenous moderate post-contrast enhancement. Dural tail is seen

Meningioma

Meningothelial meningioma

33

22/F

Right eyelid drooping diplopia

–

ND

Right parasellar lesion. Homogenous moderately hyperintense lesion on both T2WI and FLAIR images. Homogenous enhancement. Lobulated lesion with dural tail

Meningioma

Chordoid meningioma

34

52/F

NA

Left cavernous sinus hemangioma

ND

Left parasellar large lesion with suprasellar extension. Appearing heterogeneously hyperintense on T2WI and FLAIR images with central hypointensity and hypointense on T1WI with heterogenous postcontrast enhancement (central nonenhancing area)

Meningioma

Cavernoma

35

67/F

Left eye ptosis, left face reduced sensation, reduced EOM

–

ND

Left parasellar lesion with suprasellar extension appearing moderately hyperintense on T2WI and FLAIR images. Hypointense on T1WI and homogenous post-contrast enhancement. Dural tail noted

Meningioma

Meningioma

36

45/F

Headache, drooping of right eyelid

ND

Right parasellar lesion with suprasellar and posterior fossa extension. Hyperintense homogenously on T2WI and FLAIR images. Lobulated. Hypointense on T1WI. Homogenous enhancement. Dural tail noted. SWI images are not available

Meningioma

Hemangioma

37

57/F

Headache and vomiting

Right ophthalmoplegia right third and fourth nerve palsy, V1/V2/V3 sensory involvement

ND

Right parasellar lesion with superior orbital fissure extension. Well defined hyperintense lesion on both T2WI and FLAIR images and hypointense on T1WI and shows punctate enhancement on early postcontrast images. Few areas of hyperintensity are seen on T1WI and few areas of hypointensity are also seen on T2WI. The same areas are appearing hypointense on SWI but no blooming is seen

Cavernous hemangioma

Cavernous hemangioma

38

44/F

Left facial weakness years, left progressive vision loss

Left eye ptosis

ND

Moderately hyperintense on T2WI and FLAIR images with post-contrast enhancement

Left sided meningioma with ICA encasement

Fibrous meningioma

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