Characteristic MRI Features of Meckel's Cave Venous Malformation: A Case Report

Venous malformations of Meckel's cave are exceedingly rare lesions, with previously reported cases either predating modern MRI or requiring histopathological confirmation. We present the case of a 70-year-old male who was referred to our institution following detection of a left Meckel's cave lesion on MRI performed for headache and dizziness. MRI demonstrated a well-defined 21 × 12 mm lesion exhibiting marked T2 hyperintensity, T1 isointensity, absence of diffusion restriction on diffusion-weighted imaging, and progressive centripetal nodular enhancement following intravenous contrast administration. Balanced fast-field echo sequence confirmed the lesion's location within Meckel's cave. These imaging characteristics supported an imaging-favored, non-invasive diagnosis of Meckel's cave venous malformation, and conservative management with follow-up was recommended. Recognition of this characteristic MRI pattern (T2 hyperintensity, facilitated diffusion, and progressive centripetal enhancement) supports differentiation of venous malformation from more common Meckel's cave lesions such as schwannoma, meningioma, and epidermoid cyst, and may reduce reliance on unnecessary surgical intervention.