Falco-Tentorial Meningioma Producing Irreversible Midbrain Damage

Abstract

Abstract Meningiomas arising from the falcotentorial junction are the rarest subgroup of tentorial menigiomas. Because of the distance from the brain surface and the surrounding deep cerebral veins these lesions are difficult and dangerous to treat surgically. A 45-year-old female presented with the history of progressive headache, disorientation, unsteadiness, and urinary incontinence for over 6 months. The patient developed difficulty in swallowing, and weakness of all four limbs for the last 7 days. CT scan brain plain and contrast showed a large well defined, homogenously enhancing mass lesion in the peineal region with compression of the upper brain stem and obstructive hydrocephalus. Inspite of the good surgical decompression the patient did not do well. As described in the literature, the compression of the midbrain can cause severe respiratory disturbances with fatal outcome; probably the similar mechanism resulted in poor outcome in present case. As we noticed the diffuse hypodensity in midbrain on CT scan, similar findings have been described in literature in cases of transtentorial herniation with poorer outcome.