Principles and Management for High Grade Gliomas

Comparing Post-operative Maximum Residual Tumour Thickness in High Grade Glioma

Current Concepts in Management of Metastatic Brain Tumour

Literature review of management of pineal region tumour

Literature Review Of Management Of Pineal Region Tumour

Metastatic Squamous Cell Carcinoma

•53 Years old Gentleman
Chronic smoker with underlying COAD
Developed progressive left sided limbs weakness for 2 months, associated with headache.
No other symptoms on systemic review
GCS full, PEARL
Higher mental function intact

No cranial nerves deficit noted
Left hemiparesis 4/5 with no sensory impairment
No cerebellar sign
Other examinations - Normal

MRI showed homogenous enhancing lesion at right motor cortex, left insular and left cerebellum

Tumour markers done – within normal value
CXR - NAD
CT thorax and abdomen - NAD

•Right parietal craniotomy and excision of tumour done under IGS transsulcus approach

Frozen section sent- Metastatic tumour

Post-operatively, his weakness remain same.
On follow-up 2 weeks after surgery his weakness improved
HPE = Metastatic squamous cell carcinoma

Tumours Of The Cerebellopontine angle

Tumours Of The Cerebellopontine angle

Brain Metastasis of Testicular Yolk Sac Tumour

28 Years old Male
Diagnosed Left testicular tumour with lungs metastasis 1 year ago
Underwent left orchidectomy and HPE diagnosis of Yolk sac Tumour
He had completed radiotherapy and chemotherapy
Presented with 1/12 history of progresive left sided body weakness and numbness
Associated with worsening headache
Admitted with 1 episode of generalised tonic clonic seizure
O/E Pink, alert
GCS full
PEARL
BP 120/71
PR 77
Higher mental function intact
No cranial nerves deficit noted
Left hemiparesis 3/5 with sensory impairment

CT scan brain (plain + contrast) done showing homogenous enchanced tomour over right post central gyrus with marked surrounding edema




MRI was performed and he was planned for surgery






He underwent right parietal craniotomy and tumour excision. The tumour was just below a thin grey matter of post central gyrus (detected using intra-operative ultrasound). Post-central gyrus corticotomy done.
The tumour was pink-greyish in colour, soft to firm in consistency, well-circumscribed with surrounding gliotic brain tissue, highly vascular- completely excised

Post-operatively he was extubated and maintained on dexamethasone.
Clinically he still having left hemiparesis power of 3/5

CT scan (plain) post-operative day 1 showing pneumocranium with edema, no post-operative bleeding.

Right Frontoparietal convexity meningioma

Case : 55 years old malay gentleman, withn newly diagnosed diabetes mellitus type 2 on T. Metformin 500mg bd, presented in November 2008 with progressive left sided bdy weakness since past few months and was bed-bound on presentation. CT scan and MRI brain revealed right frontoparietal convexity meningioma



CT scan on 28/11/08









Findings: There is a broad based hyperdense mass in the right parietal region measuring 7.2cm X 4.9cm (axial) with medial buckling of the grey-white matter suggesting extra-axial mass. - significant mass effect resulting in effacement of ipsilateral lateral ventricle with minimal contralateral lateral ventricular dilatation. Midline shift of 12mm to the left. - homogenous enhancement with a small area of calcification. - small area of adjacent pressure erosion. No adjacent hyperostosis. - adjacent subtle white matter odema in the right parietal lobe. No mass is seen elsewhere. Basal cisterns are not obliterated.
IMP: Extra-axial mass in the right parietal region with significant mass effect.
DD: Meningioma.



MRI on 15/1/2009

MRI BRAIN WITH CONTRAST

There is a supra-tentorial, extra-axial, right fronto parietal mass which is hypointense on T1W, hyperintense with some ares of hypointensity representing calcification on T2W images. It enhances with contrast. The mass measures 5.1 ( Trans) x 7.5 ( AP) x 5.6 ( CC). It displaces the midline by 1.3 cm and compresses the ipsilateral lateral ventricle. Meningeal tail sign positive.

IMP: Appearances consistent with right fronto-parietal convexity meningioma.


He was advised for surgery but not keen. He was readmitted a month later with one episode of generalised tonic clonic seizure. He was started on phenytoin. In May 2009, he presented with behavioural changes and has been very aggressive. During this admission, the surgery was consented.

PHYSICAL EXAMINATION General : GCS full
power of the lefty side - 4/5

He underwent right frontoparietal craniotomy and tumour excision (Simpson's II) on 16/6/2009

Post-op he was extubated and recovered well.

Post-op CT scan on 17/6/2009

He was discharged well and planned for repeat MRI in 6 weeks.