case_images: PMC10808634_01
case_images: Panels of serial preoperative axial postcontrast T1 and FLAIR images in a 35-year-old patient with recurrent left hemispheric glioma. Axial postcontrast (A) and FLAIR (B) images showing a non-enhancing large left frontal tumor prior to first resection in 2012. Nine years later, he presented with expansile T2 hyperintense (C) tissue with minimal punctate enhancement (D) along the superior margin of the resection cavity within the left middle frontal gyrus. Interval tumor progression 2 years later, with progressive confluent nodular heterogeneous, solid mass-like enhancement (E) with surrounding unenchanting T2 hyperintensity (F) in the left frontal lobe at the anterior and superior margins of the previous left frontal opercular region resection cavity. FLAIR, fluid-attenuated inversion recovery.
case_images: fsurg-10-1282013-g001.jpg
case_images: PMC10808634_01_fsurg-10-1282013-g001.jpg
case_images: F1
case_images: He had been diagnosed 7 years prior with glioma-related epilepsy and treated with levetiracetam (Figures 1A,B). Prior to surgery, brain MRI was repeated (Figures 1C,D). Following his tumor board re-presentation, a recommendation was made for a third brain tumor surgery with awake craniotomy with DES, with another brain MRI performed shortly before surgery (Figures 1E,F). Moreover, Figures 1 and 2 provide serial pre- and postoperative brain MRIs that were obtained prior to and following the three surgeries for recurrent left hemispheric glioma in our patient.
case_images: Panels of serial postoperative axial postcontrast T1 and FLAIR images in a 35-year-old patient who underwent repeated glioma resections for recurrent left hemispheric glioma. Axial postcontrast (A) and FLAIR (B) images showing fluid collection in the left frontal lobe surgical cavity on postoperative day 0 following the first glioma resection in 2012. Following the second surgery, early postoperative axial images taken on postoperative day 0 showed vascular and gyral enhancement (C) and decreased and increased FLAIR signal intensity (D) in the surgical cavity. Following the third surgery 2 years later, on postoperative day 0, axial images showed a region of unresectable enhancement in the left periventricular white matter and corpus callosum (E) and a hyperintense T2 FLAIR signal surrounding the resection cavity extending across the corpus callosum into the right frontal lobe (F). FLAIR, fluid-attenuated inversion recovery.
case_images: fsurg-10-1282013-g002.jpg
case_images: PMC10808634_01_fsurg-10-1282013-g002.jpg
case_images: F2
case_images: DES at another facility. Details of intraoperative electrocorticography (iECoG) and DES were unavailable, but a brain MRI on postoperative day 0 showed gross total resection (Figures 2A,B). On postoperative day 0, another brain MRI was performed, which demonstrated gross total resection (Figures 2C,D). A brain MRI on postoperative day 0 demonstrated a region of enhancement in the left periventricular white matter and corpus callosum, with a T2 hyperintense signal around the resection cavity that extended to the right frontal lobe through the corpus callosum (Figures 2E,F). Moreover, Figures 1 and 2 provide serial pre- and postoperative brain MRIs that were obtained prior to and following the three surgeries for recurrent left hemispheric glioma in our patient.