Extracranial meningioma as an incidental infratemporal fossa mass in a patient presenting with a history of traumatic brain injury

The lesion had an intracranial origin involving the left cavernous sinus and middle cranial fossa with extracranial extension through the foramen rotundum and inferior orbital fissure, causing mild mass effect on the adjacent brain and muscles of mastication without oedema (figure 1). Given the trans-spatial location with extension through the skull base foramen, the differential diagnosis included nerve sheath tumour, venolymphatic malformation, meningioma and less likely malignant tumour. The patient was referred to ear, nose and throat (ENT), and contrast-enhanced MRI of the skull base and CT neck were recommended for further evaluation. MRI with contrast demonstrated an intracranial lesion involving the central skull base with a dural-based attachment and extension through the foramen rotundum into the infratemporal fossa (figure 2). Axial post-contrast T1 weighted MR image demonstrates a dural-based attachment (arrowhead), along with smooth expansion of the left foramen rotundum and inferior orbital fissure (arrow); note the intracranial component within the middle cranial fossa (asterisk) and the extra-cranial component lateral to the lateral orbital wall (curved arrow).