PMC4392548_01
MRI (a) Sagittal T2-weighted MRI showing a large posterior fossa ependymoma, extending from the fourth ventricle to the C2 level. (b) Axial T1-weighted MRI with contrast, showing a fourth ventricle ependymoma passing by the foramen of Margendie
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F1
Magnetic resonance imaging (MRI) demonstrated the existence of a large lesion, suggestive of ependymoma, which extended from the floor of the fourth ventricle, emerged from the foramen of Magendie and descended to the C2 level [Figure 1].
Aspect of the tumor after craniotomy and laminectomy, suggestive of ependymoma
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F2
The patient was submitted to median suboccipital craniotomy and C1 laminectomy in the park bench position with the left side down [Figure 2].
Computed tomography. (a) Image showing frontal and parietal left hemisphere hemorrhage. (b) Image showing occipital right hemisphere hemorrhage
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F3
Therefore a brain computed tomography (CT) was carried out immediately after surgery [Figure 3], which showed multiple supratentorial hemorrhages.
Computed tomography showing diffuse brain edema and basal cistern effacement
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F4
A new brain CT was carried out [Figure 4], which demonstrated a diffuse cerebral edema.