case_images: PMC10629313_01
case_images: Preoperative gadolinium contrast-enhanced magnetic resonance imaging images of the spinal cord. (a) T2-weighted sagittal image. Spinal cord enlargement is seen from C2 to Th2 levels (red arrowhead), with no spinal fluid cavity signal identified. (b and c) Sagittal T1-weighted images of the whole spinal cord with gadolinium contrast enhancement. Diffuse patchy enhancement is evident.
case_images: SNI-14-360-g001.jpg
case_images: PMC10629313_01_SNI-14-360-g001.jpg
case_images: F1
case_images: T1 images showed heterogeneous enhancement of the swollen spinal cord [Figure 1]. The patient's symptoms rapidly progressed just before surgery, resulting in abdominal breathing. Therefore, the patient underwent tumor biopsy, C2 domotomy, and C3-C7 decompressive laminectomy with expansive duroplasty to verify the final diagnosis and decide further therapy options. The pathological diagnosis was DMG, H3K27-altered.
case_images: Nonenhanced head-and-neck computed tomography scan on the 7th day after surgery. Acute obstructive hydrocephalus developed due to spinal cord swelling from the lower part of the medulla oblongata to the level of the upper cervical spine at the craniovertebral junction.
case_images: SNI-14-360-g002.jpg
case_images: PMC10629313_01_SNI-14-360-g002.jpg
case_images: F2
case_images: On postoperative day 7, when the patient's overall condition stabilized, head-and-neck CT revealed acute hydrocephalus and diffuse hypodensity in the cervical spinal cord [Figure 2], and an emergency third ventriculostomy was performed.
case_images: Cervical gadolinium contrast-enhanced magnetic resonance (MR) imaging. (a) T2-weighted sagittal image showing severe atrophy of the spinal cord with little or no normal spinal cord tissue present. A liquid mass was observed in the fourth ventricle, suggesting a tumor with liquefaction changes. (b) Gadolinium-contrasted T1-weighted sagittal image. Partial contrast enhancement diffusely presented in the spinal cord, with spinal cord dissemination or residual tumor suspected. (c) Syringomyelia was observed on the axial T1-weighted plain MR image (red arrowhead).
case_images: SNI-14-360-g003.jpg
case_images: PMC10629313_01_SNI-14-360-g003.jpg
case_images: F3
case_images: Contrast-enhanced MR imaging of the whole spine 2 months after the surgery revealed diffuse heterogeneous enhancement of the atrophic spinal cord in suspicion of the disseminated lesion or residual tumors with multiple syrinxes [Figure 3].