When It Looks Like a Duck and Walks Like a Duck: Importance of DOTATATE PET Imaging in Assessing Putative Sphenoid Wing Meningioma for Stereotactic Radiosurgery

MRI is central to evaluating skull-base lesions, but morphologic features alone can misclassify vascular anomalies as neoplasms. A 27-year-old man presented with left monocular diplopia and an enhancing dural-based lesion along the lateral-superior wall of the left cavernous sinus, read as a sphenoid-wing meningioma. He was evaluated for stereotactic radiosurgery. Incorporation of ⁶⁸Ga-DOTATATE PET demonstrated no somatostatin receptor avidity, prompting neuroradiology re-review of prior angiography and subsequent orbital CT that supported a cavernous-sinus venous varix. Stereotactic radiosurgery was withheld, and the patient remained clinically stable on observation with a second DOTATATE PET confirming non-avidity. This case highlights the value of DOTATATE PET as a complementary study for indeterminate skull-base lesions, particularly when tissue diagnosis is unavailable, to prevent inappropriate intervention.