presentation1, radiological imaging of trigeminal schwanoma
TRANSCRIPT
Dr ABD ALLAH NAZEER MD
Radiological imaging of trigeminal schwannoma
5 Parts of trigeminal nerve 1-Brain stem bdquo 2- Cistern 3- Ganglion bdquo4- Cavernous sinus 5- Peripheral Divisions
Trigeminal nerve Apparent origin (white arrows) and pontocerebellar trajectory (red arrows) 1 Internal auditory canal 2 Pontocerebellar cistern 3 Cochlea
4 Vestibule 5 External semicircular canal 6 Superior semicircular canal
Trigeminal schwannomas are uncommon slow-growing
encapsulated tumours composed of schwann cells They are the second most common intracranial schwannoma far less common than acoustic schwannoma and has a predominantly benign growth
EpidemiologyPatients usually present in middle age typically the 3rd to 4th decades They make up a third of tumours of Meckels cave while accounting for less than 02 of all intracranial tumours Although intracranial schwannomas are common making up approximately 8 of all intracranial tumours the vast majority around 90 are acoustic schwannomasAs with other schwannomas there is an association with neurofibromatosis type 2
Clinical presentationTypically clinical presentation relates to trigeminal nerve dysfunction eg neuralgia neurasthenia or numbness If large then mass effect symptoms may be present There may be a slight female predilection
Radiographic featuresTrigeminal schwannomas share the imaging findings of schwannomas elsewhereTypically trigeminal schwannomas usually have a dumbbell appearance when they extend both in the cisternal and cavernous sinus They can however if small be confined to one compartment or section of the nerve
preganglionic (cisternal)confined to the cerebello-pontine angle
ganglionic (gasserian ganglion)confined to Meckels cavemost common
postganglioniceither confined to the cavernous sinus or extend through respective base of skull foraminaaccount for in 10 of casesmost frequently involve the ophthalmic division but can be found on all three divisionsschwannomas confined to the extra cranial compartment are rare
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
5 Parts of trigeminal nerve 1-Brain stem bdquo 2- Cistern 3- Ganglion bdquo4- Cavernous sinus 5- Peripheral Divisions
Trigeminal nerve Apparent origin (white arrows) and pontocerebellar trajectory (red arrows) 1 Internal auditory canal 2 Pontocerebellar cistern 3 Cochlea
4 Vestibule 5 External semicircular canal 6 Superior semicircular canal
Trigeminal schwannomas are uncommon slow-growing
encapsulated tumours composed of schwann cells They are the second most common intracranial schwannoma far less common than acoustic schwannoma and has a predominantly benign growth
EpidemiologyPatients usually present in middle age typically the 3rd to 4th decades They make up a third of tumours of Meckels cave while accounting for less than 02 of all intracranial tumours Although intracranial schwannomas are common making up approximately 8 of all intracranial tumours the vast majority around 90 are acoustic schwannomasAs with other schwannomas there is an association with neurofibromatosis type 2
Clinical presentationTypically clinical presentation relates to trigeminal nerve dysfunction eg neuralgia neurasthenia or numbness If large then mass effect symptoms may be present There may be a slight female predilection
Radiographic featuresTrigeminal schwannomas share the imaging findings of schwannomas elsewhereTypically trigeminal schwannomas usually have a dumbbell appearance when they extend both in the cisternal and cavernous sinus They can however if small be confined to one compartment or section of the nerve
preganglionic (cisternal)confined to the cerebello-pontine angle
ganglionic (gasserian ganglion)confined to Meckels cavemost common
postganglioniceither confined to the cavernous sinus or extend through respective base of skull foraminaaccount for in 10 of casesmost frequently involve the ophthalmic division but can be found on all three divisionsschwannomas confined to the extra cranial compartment are rare
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Trigeminal nerve Apparent origin (white arrows) and pontocerebellar trajectory (red arrows) 1 Internal auditory canal 2 Pontocerebellar cistern 3 Cochlea
4 Vestibule 5 External semicircular canal 6 Superior semicircular canal
Trigeminal schwannomas are uncommon slow-growing
encapsulated tumours composed of schwann cells They are the second most common intracranial schwannoma far less common than acoustic schwannoma and has a predominantly benign growth
EpidemiologyPatients usually present in middle age typically the 3rd to 4th decades They make up a third of tumours of Meckels cave while accounting for less than 02 of all intracranial tumours Although intracranial schwannomas are common making up approximately 8 of all intracranial tumours the vast majority around 90 are acoustic schwannomasAs with other schwannomas there is an association with neurofibromatosis type 2
Clinical presentationTypically clinical presentation relates to trigeminal nerve dysfunction eg neuralgia neurasthenia or numbness If large then mass effect symptoms may be present There may be a slight female predilection
Radiographic featuresTrigeminal schwannomas share the imaging findings of schwannomas elsewhereTypically trigeminal schwannomas usually have a dumbbell appearance when they extend both in the cisternal and cavernous sinus They can however if small be confined to one compartment or section of the nerve
preganglionic (cisternal)confined to the cerebello-pontine angle
ganglionic (gasserian ganglion)confined to Meckels cavemost common
postganglioniceither confined to the cavernous sinus or extend through respective base of skull foraminaaccount for in 10 of casesmost frequently involve the ophthalmic division but can be found on all three divisionsschwannomas confined to the extra cranial compartment are rare
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Trigeminal schwannomas are uncommon slow-growing
encapsulated tumours composed of schwann cells They are the second most common intracranial schwannoma far less common than acoustic schwannoma and has a predominantly benign growth
EpidemiologyPatients usually present in middle age typically the 3rd to 4th decades They make up a third of tumours of Meckels cave while accounting for less than 02 of all intracranial tumours Although intracranial schwannomas are common making up approximately 8 of all intracranial tumours the vast majority around 90 are acoustic schwannomasAs with other schwannomas there is an association with neurofibromatosis type 2
Clinical presentationTypically clinical presentation relates to trigeminal nerve dysfunction eg neuralgia neurasthenia or numbness If large then mass effect symptoms may be present There may be a slight female predilection
Radiographic featuresTrigeminal schwannomas share the imaging findings of schwannomas elsewhereTypically trigeminal schwannomas usually have a dumbbell appearance when they extend both in the cisternal and cavernous sinus They can however if small be confined to one compartment or section of the nerve
preganglionic (cisternal)confined to the cerebello-pontine angle
ganglionic (gasserian ganglion)confined to Meckels cavemost common
postganglioniceither confined to the cavernous sinus or extend through respective base of skull foraminaaccount for in 10 of casesmost frequently involve the ophthalmic division but can be found on all three divisionsschwannomas confined to the extra cranial compartment are rare
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Radiographic featuresTrigeminal schwannomas share the imaging findings of schwannomas elsewhereTypically trigeminal schwannomas usually have a dumbbell appearance when they extend both in the cisternal and cavernous sinus They can however if small be confined to one compartment or section of the nerve
preganglionic (cisternal)confined to the cerebello-pontine angle
ganglionic (gasserian ganglion)confined to Meckels cavemost common
postganglioniceither confined to the cavernous sinus or extend through respective base of skull foraminaaccount for in 10 of casesmost frequently involve the ophthalmic division but can be found on all three divisionsschwannomas confined to the extra cranial compartment are rare
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
CTSchwannomas are typically isodense to brain and can be difficult to identify depending on location Cystic areas (usually found in larger tumours) are hypodense similar to CSF Following administration of contrast they moderately enhance often heterogeneously due to cystic areasBone algorithm is excellent at assessing bony margins especially useful when the tumor extends into or through a foramen As these lesions are slow growing they remodel the bone with smooth borders
MRIMRI is the investigation of choice for assessment of intracranial schwannomas not only due to greater contrast resolution but also exquisite anatomical details which allows for precise localization of the tumor
T1typically isointense to braincystic areas if present are hypointense
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
T2typically somewhat hyperintense to braincystic areas are hyperintenselesion in Meckel cave contrasts sharply on coronal T2 with contralateral normal mostly CSF filled
T1 C+prominent enhancementheterogenous in 70 of cases
DWIADCoften higher signal on both DWI and ADC (T2 shine through not restricted diffusion)
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate an enhancing lesion arising from the cisternal segment of the right trigeminal nerve
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T1 pre (A) and T1 post contrast (B) MR images demonstrate a small avidly enhancing lesion in relation to the cisternal segment of
the left trigeminal nerve just proximal to Meckelrsquos cave
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T2 (A) T1 pre (B) and T1 post contrast (C) MR images demonstrate a large homogenously enhancing dumbbell-shaped extra-axial mass extending from the posterior fossa to Meckelrsquos cave on the right along the expected course of the trigeminal nerve
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T2 (A) axial T1 pre (B) and axial T1 post contrast (C) MR images demonstrate a globular enhancing mass in the right Meckelrsquos cave arising from the trigeminal ganglion
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images demonstrate enhancing masses in bilateral cerebello-pontine angle cisterns and right Meckelrsquos cave This patient was diagnosed with neurofibromatosis 2 with bilateral vestibular schwannomas and right trigeminal ganglion schwannoma
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T1 pre (A) and axial T1 post contrast (B) MR images demonstrate an avidly enhancing mass in the right cavernous sinus and Meckelrsquos cave
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial contrast-enhanced CT image shows a large enhancing mass centered in the right cavernous sinus and Meckelrsquos cave with significant local mass effect
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Axial T1 post contrast (A) and coronal T1 post contrast (B) MR images in a 51-year-old female demonstrate a large enhancing mass in the region of left foramen ovale with minimal extra cranial extension
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Trigeminal schwannoma T1 and T2 weighted MR images show a bilobulated mass in right Meckelrsquos cave and cerebello-pontine cistern with homogeneous intense post-contrast enhancement
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Giant Trigeminal Schwannoma Presenting with Obstructive hydrocephalus
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Representative axial T-1 weighted post-gadolinium images used for volumetric analysis showing the progressive postsurgical reduction of tumor volume A Preoperative B Three months postoperatively C One-year post-operatively
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
(a-c) Preoperative MRI of brain showing right-sided huge trigeminal schwannoma (axial coronal and sagittal views sequentially) (d-f) Postoperative MRI of brain showing the
complete removal of tumor (axial coronal and sagittal views sequentially)
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Mixed schwannoma with meningioma of the trigeminal nerve
Thank You
Thank You