60yrs old male patient presented with complaints of dropping of left eyelid, intermittent headache with loss of vision in left eye,at present patient is conscious with positive focal neurological deficit.K/c/o HTN on regular medications.Kindly opine??

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Plain ct shows suprasellar, parasellar hyperdense lesion involing the left cavernous sinus & LTmedial temporal also . Faint contrast enhancement noted. MRI abnormal material with in the expanded left cavernous sinus. Isointense on T1 mildly hyperintense on T2 & enhances homogeneously with out any dural tail along the petrous apex. The mass extends in to the left orbital apex Tumor calcifications& hyperosteosis in ct are not seen. DD only I can consider. Nerve sheath tumor Chordoma / chondrosarcoma Sarcoidosis / other granulomatous lesions. Pituitary adenoma Among the cavernous sinus masses , it is important to exclude ICA aneurysm. Other is cavernous sinus meningioma, but the characteristic findings are not seen which include encasement or narrowing of ICA, tumoral calcification/ hyperosteosis, presence of enlarged dural tail.

Mri Brain - Parasellar meningioma extended to lt.sphenoid with lt.temporal region engulfing the left internal carotid artery in cavernous portion producing lt.ptosis and vision problem . On imaging looks exophthalus due lt orbital apex involvement Temperory we can give steroid injection to reduced inflammation and headache Decompression and excision of mass followed by radiation.

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Cavernous sinus mass Meningioma, fungal granuloma, other tumours Get an mr contrast and ct angio

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parasellar meningioma reaching upto medial sphenoid wing.

Cavernous sinus mass with meningioma, would suggest an MRI contrast and MRA

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Patient refused for surgery

Anterior clinoid meningioma/ dorsum sella meningioma with cavernous sinus extension and encircling ICA . Needs surgery for decompression

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