A Giant Meningioma of the Posterior Fossa Extending to the Para Pharyngeal Space, MRI Findings

Meningiomas involving the jugular foramen and parapharyngeal space are extremely rare. They most commonly occur intracranially and then extend to the extra cranial region through the foramen of the skull base, such as jugular foramen. Preoperative diagnosis and extensions of the lesions by imaging may predict the post-operative morbidity. We present a case of extra cranial spread of a giant posterior fossa meningioma extending into the internal jugular vein and perineural spaces, presenting as a cervical mass with encasement of the internal carotid artery and cranial nerves. Meningiomas involving the skull base, the neural foramina, the jugular foramen can present surgical challenges. Extra cranial extension of meningioma is uncommon, and direct intraluminal spread within the internal jugular vein to the neck is a rare finding. Imaging has an important role in identifying the lesions, detecting tumour-related complications and in presurgical differential diagnosis, which is essential for optimizing treatment strategies. MRI is the main tool of meningioma imaging because of its superior soft-tissue resolution and multiplanar capabilities. Appropriate preoperative imaging differential diagnosis and treatment planning are essential in these patients.