Answer Meningioma

No skull fracture is present. There is a 3 cm diameter oval opacity of calcific density projected over the skull vault. Possibilities would include a calcified meningioma or possibly a giant calcified aneurysm. A frontal skull X-ray should be reviewed to confirm that the lesion is within the skull vault. A CT scan of the brain would be a suitable next request (see Fig. 5.24).

The CT scan demonstrates a densely calcified lesion arising from the middle cranial fossa which is extra-axial (outside of the brain). These are features characteristic of a calcified meningioma.

One of the great advantages of MRI scanning is its multiplanar capability and coronal imaging clearly confirms the extra-axial nature of the lesion

Fig. 5.23 Quiz case.

Fig. 5.25 MRI of meningioma. The extra-axial nature of the meningioma is clearly seen on this coronal MRI scan. The brain can be seen displaced, but separate from the tumour.

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