• Where is the lesion Extraaxial Scwhannoma

Meningioma
 Extra-axial (external to the pia) Epidermoid
Metastases
 Intra-axial (beneath the pia)

 Supratentorial

 Infratentorial EXTRA-AXIAL TUMORS:Meningioma

Pituitary adenoma
• How old is the patient
Craniopharyngioma
 Child
Schwannoma
 Adult

INTRA-AXIAL VS EXTRA-AXIAL
INTRA-AXIAL
• Narrows CSF space
• Displaces cortex toward
periphery
• Gray matter stretched over
lesion
1. MENINGIOMA
EXTRA-AXIAL • Common locations convexity, interhemispheric, tent.
• Widens CSF space Classically iso to GM on all sequences.
• Displaces brain; deeper
lesion has a broad base • Most common extraaxial neoplasm of adults
toward dura
• Gray-white matter • 15 % of primary intracranial neoplasms,
“buckling”
• Peak 50-60 y.o., F 2:1 intracranial, 4:1 intraspinal

INTRA-AXIAL • CT

Location Differential Diagnosis

• Cortex
• Gray-white junction
• Deep white matter
• intraventricular
 Hyperdense
• Glioma
• Medulloblastoma
• Hemangioblastoma  Variable edema (possibly extensive),
• Metastases
 Intense enhancement

EXTRA-AXIAL  Dural tail (60%) – nonspecific,

Location Differential Diagnosis  +/- cysts, +/- fat

• Subarachnoid • Meningioma
• Subdural • Pituitary adenoma  Vascular supply: ECA 85%, ICA 63%- “mother in law
• Epidural • Craniopharyngioma
sign”- comes early, stays late
• Calvarium • Schwanomma
• Subgaleal • Chordoma
• Scalp (soft-tissues) • Dermoid/epidermoid, cyst, • MRI
lipoma
• Metastasis  Distinguishing features: lens shaped/ plaque-like
appearance, hypo T2

BRAIN TUMORS IN CHILDREN  Meningiomas typically hypo T2 due to fibrous content

Supratentorial (52%)
• Low grade astrocytoma
• Craniopharyngiomas
or calcification,
Infratentorial (48%)
• Cerebellar astrocytoma  Strongly enhance, iso noncom T1. Broad dural base,
• Brainstem gliomas
extraaxial, +/- dural tail
• Medulloblastomas
• Ependymomas

BRAIN TUMORS IN ADULTS

***A 63 y.o. M with mild dementia and decreased vision left
Supratentorial (80-85%)
eye
Intraaxial Astrocytoma
Oligodendroglioma
Extraaxial Meningioma
Pituitary adenoma

Infratentorial (uncommon)
Meningioma

On MRI: T1 – similar to brain parenchyma, min. CSF cleft,

buckling cortex, homogenous enhancement, dural tail