case_images: PMC9853524_01
case_images: Pre-op MRI scan with T1 post gad and T2 weighted images showing right sided heterogeneous intraventricular lesion with low T2 signal likely calcified components with some areas of avid gadolinium enhancement.
case_images: fsurg-09-1065979-g001.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g001.jpg
case_images: F1
case_images: SEGA during investigation for migraine (Figure 1).
case_images: Pre-operative mapping and trajectory planning, Green - CST (cortico spinal tract), Blue - FAT, Magenta - Tumor.
case_images: fsurg-09-1065979-g002.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g002.jpg
case_images: F2
case_images: Surgical resection was performed with pre-operative tractography and mapping (Figures 2A,B) A transsulcal minimally invasive parafascicular approach (tsMIPS) was carried out using NICO BrainPath system  with assistance of neuronavigation, 5-ALA, intraoperative neurophysiological monitoring (IONM), and intraoperative ultrasound.
case_images: Tumor showing part bright Fluorescence intraoperatively.
case_images: fsurg-09-1065979-g003.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g003.jpg
case_images: F3
case_images: Intraoperatively, the tumor was found to have both bright and pale fluorescence under Blue 400 filter:Zeiss Pentero 900 (Carl Zeiss Meditec ), in the cystic and solid components respectively (Figures 3A,B).
case_images: Intraoperative US artefact caused by Residual intraventricular blood and calcified component.
case_images: fsurg-09-1065979-g004.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g004.jpg
case_images: F4
case_images: No fluorescence was perceived at the end of resection (Figure 4).
case_images: 3-Year Follow-up Postoperative MRI - Axial (A) - T1-Gad weighted, (B) - FLAIR and (C) - T2 weighted, Coronal (D) - T1-Gad weighted and Sagittal (E) - T1-Gad weighted) images showing near total resection with minor contrast enhancing in the lateral walls of the third ventricle and in the fornices. This is the last follow-up scan and the patient has not received further treatment apart from surgery.
case_images: fsurg-09-1065979-g005.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g005.jpg
case_images: F5
case_images: Histology- Areas of epithelioid appearances with large vesicular nuclear and prominent nucleoli associated with abundant granular or ground glass cytoplasm, merged with spindle-shaped cells forming compact glial fibrillary background. Focal calcification visible, tumor also attached to ependymal cells.
case_images: fsurg-09-1065979-g006.jpg
case_images: PMC9853524_01_fsurg-09-1065979-g006.jpg
case_images: F6