case_images: PMC8720440_01
case_images: MRI of the skull base at the time of initial presentation: Preoperative axial sequence (a) and sagittal sequence (b) with contrast. Postoperative gross total resection with combined endoscopic endonasal and transfrontal sinus craniectomy on MRI axial (c), and sagittal (d) with contrast.
case_images: SNI-12-606-g001.jpg
case_images: PMC8720440_01_SNI-12-606-g001.jpg
case_images: F1
case_images: Magnetic resonance imaging showed evidence of Kadish C disease [Figure 1a and b]. Gross total resection of the tumor through a combined endoscopic endonasal and transfrontal sinus craniectomy was performed [Figure 1c and d].
case_images: Brain fast spoiled gradient echo sequences with contrast depicting multiple meningeal metastases that are targeted during the second Gamma Knife Radiosurgery (GKRS) treatment, with the margin dose labeled in yellow on the sagittal (a) and coronal (b) planes on the day of GKRS. Interval follow-up imaging after GKRS showing treatment response and decrease in tumor volume on sagittal (c) and coronal (d) sequences.
case_images: SNI-12-606-g002.jpg
case_images: PMC8720440_01_SNI-12-606-g002.jpg
case_images: F2
case_images: He received GKRS for a total of 12 dural-based metastases [Figure 2a and b]. Interval follow-up imaging after GKRS showing treatment response and decreased in tumor volume on sagittal [Figure 2c] and coronal [Figure 2d] sequences, which concurred with previous findings on prognostication for low-grade Hyams Grade I/II tumors.
case_images: MRI brain FLAIR sequence demonstrating pericranium radiation necrosis of the frontal lobes (a), and CT head demonstrating flap compromise with intracerebral air (b). DSA performed postoperatively that demonstrates on the right coronal ICA injection an atretic ACA that fills sluggishly to the mid A2 segment where it abruptly stops (c). The left coronal ICA injection reveals irregularities in the distal branches of the A2 and A3 segments that are consistent with radiation changes (d).
case_images: SNI-12-606-g003.jpg
case_images: PMC8720440_01_SNI-12-606-g003.jpg
case_images: F3
case_images: There were radiographic findings of radiation necrosis and pericranium flap breakdown [Figure 3a and b]. Given the caliber and quality of the vessel in the setting of multiple previous radiation treatments, it was controlled intraoperatively with sacrifice of the vessel, as seen on diagnostic angiogram (DSA) immediately postoperatively [Figure 3c]. There were also irregularities of the left distal branches of A2 and A3 segments likely consistent with postradiation changes DSA [Figure 3d].