case_images: PMC8326072_01
case_images: Intraoperative neuronavigation (Brainlab , Munich, Germany) demonstrating lesion mapping and trajectory planning through topographic, axial, sagittal, and coronal views (clockwise, left panel). Postoperative wound dressing and secured drug delivery catheter, reflecting the right occipital-parietal entry point (right panel).
case_images: SNI-12-337-g001.jpg
case_images: PMC8326072_01_SNI-12-337-g001.jpg
case_images: F1
case_images: The catheters were secured in a 14 French Foley catheter (red rubber tubing), stab wounds were then closed with 3-0 Nylon (Neurolon) sutures and the patient was transferred, intubated to the MRI suite [Figure 1].
case_images: Intraprocedural MRI after placement of two flexible catheters for convection-enhanced delivery of MDNA55. Catheter position (white arrowheads) confirmed in ideal location by the release of gadolinium contrast agent (white arrow).
case_images: SNI-12-337-g002.jpg
case_images: PMC8326072_01_SNI-12-337-g002.jpg
case_images: F2
case_images: The catheter position was confirmed in ideal location as noted by the release of gadolinium during MRI [Figure 2].
case_images: Axial coregistered postcontrast T1-weighted image (PC T1), T2-FLAIR, and corresponding mean diffusivity (MD), fractional anisotropy (FA), and cerebral blood volume (CBV) maps are shown at baseline, 1-month, and at 3-month follow-up periods. There was a striking reduction of contrast enhancement, and CBV (white arrows), more apparent at 1-month follow-up compared to the baseline, with increased MD and decreased FA.
case_images: SNI-12-337-g003.jpg
case_images: PMC8326072_01_SNI-12-337-g003.jpg
case_images: F3
case_images: Increased mean diffusivity (MD) along with decreased fractional anisotropy (FA) and rCBVmax was noted at follow-up relative to baseline consistent with tumor response, with reduced cellularity and vascular normalization [Figures 3 and 4].
case_images: Percent changes in MR parameters (MD, FA, and rCBV) at follow-up periods relative to baseline. MD: Mean diffusivity, FA: Fractional anisotropy, rCBV: Relative cerebral blood volume.
case_images: SNI-12-337-g004.jpg
case_images: PMC8326072_01_SNI-12-337-g004.jpg
case_images: F4
case_images: Increased mean diffusivity (MD) along with decreased fractional anisotropy (FA) and rCBVmax was noted at follow-up relative to baseline consistent with tumor response, with reduced cellularity and vascular normalization [Figures 3 and 4].