PMC9699851_01
MRI imaging findings and intraoperative photographs in Case 1. (A) Preoperative MRI imaging including T1-weighted imaging (a; axial) and contrast-enhanced T1-weighted imaging (b; axial, c; coronal, and d; sagittal) showed a space-occupying lesion where a hemorrhagic lesion and a contrast-enhanced lesion were mixed in both frontal lobes and the genu of the corpus callosum. The maximum diameter of the lesion was 52 mm. (B) Intraoperative photographs are shown. e; Deep-seated tumor on the left side (white arrow) was resected by entering from the left side of the falx cerebri until the left anterior horn (white arrowhead) was opened. (f) The resection cavity was examined with an endoscope, inserted through the right side of the falx cerebri. The right pericallosal artery (black arrowhead) and the cavity after removal of the tumor in the corpus callosum (black arrow) are shown in this figure. (g) The bilateral tumor was totally resected through the minimal cortical incisions of both frontal lobes. (C) Postoperative MRI imaging at 1 month (h and i) and 1 year (j and k) after the surgery are shown. At 1 month, contrast-enhanced MRI (h) axial and (i) sagittal showed gross total removal of the tumor, including the lesion in the genu of corpus callosum (white arrow). Both pericallosal arteries (white arrowhead) are preserved. At 1 year, MRI (j) T1-weighted imaging and (k) contrast-enhanced T1-weighted imaging show no obvious recurrent lesion.
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F1
On admission, MRI showed a space-occupying lesion, where a hemorrhagic lesion and a contrast-enhanced lesion were mixed in both frontal lobes and the genu of the corpus callosum [Figure 1A]. Deep-seated tumors on both sides were also resected by entering from the left and right sides of the falx cerebri until the anterior horn of each lateral ventricle was opened [Figure 1B, e]. Finally, the resection cavity was examined endoscopically, including the corpus callosal margin and pericallosal artery [Figure 1B, f]. The bilateral tumor was completely resected through minimal cortical incisions in both frontal lobes [Figure 1B, g]. Postoperative MRI showed gross total removal of the tumor, including the lesion in the genu of the corpus callosum, and preservation of both pericallosal arteries [Figure 1C, h-i]. At the 1-year follow-up, MRI revealed no obvious recurrent lesions [Figure 1C, j-k].
PMC9699851_02
MRI imaging findings and intraoperative photographs in Case 2. (A) Preoperative MRI imaging including FLAIR imaging (a; axial) and contrast-enhanced T1-weighted imaging (b; axial, c; coronal, and d; sagittal) showed a space-occupying lesion with a mixture of a hemorrhagic lesion and a contrast-enhanced lesion in the medial aspect of the frontal lobes to the cingulate gyrus and corpus callosum. The maximum diameter of the lesion was 60 mm. (B) Intraoperative photographs are shown. (e) The right frontal lobe tumor was resected, and the left frontal lobe tumor was debulked as much as possible under general anesthesia. The falx cerebri was incised to preserve the inferior sagittal sinus (white arrowhead). This manipulation enabled us to resect the left-sided tumor from the right side of the falx cerebri. The patient was awakened from anesthesia with the residual tumor in the deep corpus callosum (white arrow). (f) The residual tumor in the deep corpus callosum was resected and the anterior horn of the lateral ventricle (black arrow) was opened. The right pericallosal artery (black arrowhead) and its branch vessel penetrating the tumor were carefully dissected and preserved. (C) Postoperative MRI 1 month after the surgery is shown. T1-weighted imaging (g; axial) and contrast-enhanced T1-weighted imaging (h; axial, i; coronal, and j; sagittal) showed gross total removal of the tumor, including the lesion in the anterior part of corpus callosum (white arrow). The pericallosal and callosomarginal arteries (white arrowhead) are preserved.
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F2
Preoperative MRI showed a space-occupying lesion with a mixture of hemorrhagic and contrast-enhanced lesions in the medial aspect of both the frontal lobes and corpus callosum [Figure 2A]. The falx cerebri was incised to preserve the inferior sagittal sinus and the tumor was resected from the right side of the falx cerebri [Figure 2B, e]. Postoperative MRI revealed gross total removal of the tumor, including the lesion in the anterior part of the corpus callosum [Figure 2C].