0:00

So the first case was this, um,

0:02

enhancing mass involving the anterior skull base, and we can see that it's,

0:07

uh, homogeneously enhancing. The one, uh,

0:11

little thing I did want to point out was that there was a sickening here

0:15

involved in the anterior cranial fossa,

0:17

and this is a little bit of hyperos ptosis.

0:19

And in the old days we used to call this blistering of the bone on mr. Um,

0:24

and so this was a pretty straightforward case of, um,

0:29

a meningioma involving the anterior skull base and,

0:33

uh, just with some thickening the bone,

0:36

I think with the other term that we sometimes used as a plan and sphenoid alley

0:40

meningioma. Um, the one thing I did wanna point out,

0:44

a couple people mentioned this in the, in the report,

0:48

there is a lot of vasogenic edema surrounding this. And you know, the,

0:52

the one thing that I've seen over time is that if I see this vasogenic edema,

0:57

I always thought it was due to printable invasion.

1:00

But what I've noticed is that if the,

1:04

if it's an older patient and there's a lot of brain

1:09

atrophy, the, the,

1:14

the meningioma has space to grow so the,

1:18

the brain can kind of move around it. And so therefore in older patients,

1:23

we don't see a lot of edema. But this, I believe was a younger patient,

1:27

and so there's not a lot of, uh,

1:31

extra brain volume that's not occupied by brain tissue.

1:35

So when this tumor goes, it tends to compress the brain more.

1:39

So what I've noticed that in younger patients, if I see this vasogenic edema,

1:44

it doesn't necessarily mean that there's parenchymal invasion.

1:47

It doesn't necessarily mean that it's an invasive form in angioma.

1:51

It's just that this, um, brain parenchyma, um, it,

1:56

it's more prone to have base sugar edema because the brain is just non-compliant

2:00

around, there's just no place to move.

2:02

So I can stop there and take any questions you have on this one

2:07

And Dr.

2:08

Mochi for the hyper OSIS and M R I and we just look at the

2:13

configuration or is there any changes in the Cigna intensity?

2:19

Yeah, that's a good question. In general, um, the, the,

2:22

you'll see this bone right here that's expanding in just a little bit of

2:26

irregularity. Sometimes if the bone is really, really thickened,

2:29

you can sometimes see in this case there's some, let me,

2:33

let me get this non-contrast satchel T ones because it's probably better.

2:39

See in this case we can see the normal thickening of the bone should be

2:42

basically this caliber on the right. But you see how it's expanded.

2:45

Sometimes I've noticed it just be completely dark.

2:48

And then sometimes I have notes,

2:49

some intermediate signal within this and I'm not sure if it actually represents

2:52

fibrous tissue or maybe some early creation of marrow or fat within

2:57

it. I'm not a, not a hundred percent sure,

3:00

but the signal within this can be a little bit variable. But the main thing is,

3:04

is that, um, width of the bone is, is increased.

3:08

Any other questions on this one?

3:10

So for this kind of mening,

3:12

is there any relevance to the nerve like olfactory nerve we,

3:17

do we need to mention?

3:19

Yeah, it's a good question.

3:20

I think you can mention it if you can actually see the nerve. Um, you know,

3:25

there are lots of types of names for this meningioma I've,

3:28

I've seen it called anterior skull base meningioma.

3:31

I've seen it being called um, olfactory groove meningiomas.

3:36

If it's involved in the posterior aspect of sphenoid sinus,

3:39

I call planum sphenoid alley meningiomas. Um,

3:43

in general, if you want to, in, in this particular case,

3:47

you can actually see the tumor as extending inferiorly in valve in

3:52

the olfactory sulcus.

3:54

So if you want to say that the tumor's growing into the groove of the

3:58

olfactory nerve, I think that's completely fine.

4:02

Now is there any criteria,

4:03

like is it the size that based methods for the surgery?

4:08

Like for the, for the surgery to go in uhhuh? Yeah,

4:12

That's a really good question. Um, in fact,

4:15

I was just discussing that with one of our senior skull-based surgeons the other

4:18

day. Um, a lot of it depends on the symptoms. So I've seen, um,

4:24

for instance,

4:26

I've seen people follow meningiomas and I've seen people take 'em out and

4:31

I think a lot of it is depend on, like in this particular case,

4:34

they would take it out just based on the fact of the vasogenic edema.

4:37

The patient probably had headaches so they would take it out.

4:39

But sometimes in older patients,

4:41

if they see the meningiomas and the patients are essentially asymptomatic and

4:45

there's no vasogenic edema, then you can make an argument just to,

4:48

just to follow 'em.

4:51

Okay. They answers my question.

4:53

Does it,

4:54

I assume I have seen some of the patient they just follow up imaging wise. Yes.

4:59

But because this kind of patient have genic edema,

5:01

there is a chances to be a management type even though according to what

5:06

you say may be due to the young patient for the mass effect because of the

5:11

volume. Yes.

5:13

But sometimes it's very difficult to differentiate between the management

5:16

transformation just based on imaging.

5:21

Yes. Yeah. The only thing I would add to that,

5:23

I wouldn't necessarily use the term malignant transformation. Mm-hmm.

5:26

I would just say that some of the n genomes, um,

5:29

are more aggressive than others. So maybe they're aggressive.