Diagnosis and Management of Skull Base Meningiomas

Clinical Presentation and Diagnosis

The American College of Radiology recommends that headaches and visual disturbances in patients with skull base lesions should prompt consideration of meningioma, as these symptoms are commonly associated with this condition 1, 2
Visual disturbances develop when meningiomas compress the optic apparatus, including the optic nerves, chiasm, or tracts, which is particularly common with skull base locations 1, 3
The differential diagnosis for skull base lesions with these symptoms includes schwannomas, which represent 3-5% of skull base tumors, but typically present with hearing loss rather than visual symptoms when located in the cerebellopontine angle 4
Pituitary adenomas should be considered if the lesion is sellar/suprasellar, as they commonly cause visual field defects and headaches 3

The American College of Radiology recommends obtaining MRI of the brain with and without contrast as the initial imaging study, which provides superior soft tissue characterization compared to CT and defines the tumor's relationship to adjacent structures 3, 5
Thin-section imaging through the skull base should be added if the lesion involves sellar/parasellar regions to better define involvement of the cavernous sinus and optic apparatus 3, 5
CT of the head with contrast can be used as complementary imaging to evaluate for bone involvement, hyperostosis, or erosion 3
Urgent ophthalmologic evaluation with formal visual field testing and fundoscopic examination should be arranged to document baseline visual function before intervention 3, 6

The American College of Radiology notes that visual recovery is unlikely after the first postoperative month, making timely surgical intervention critical for preserving vision in cases with progressive visual deficits 5