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T1-weighted gadolinium contrasted magnetic resonance imaging axial plan images from case 1 before (A) and 8 (B) and (C) 12 months after stereotactic radiation therapy.
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Examination revealed right-sided cranial erve (CN) IV and V palsies, and magnetic resonance imaging (MRI) showed a right cerebellopontine angle tumor involving Meckel cave (Fig. 1A). MRI demonstrated increases in both tumor size and the extent of FLAIR hyper-intensity changes within the adjacent midbrain and brain stem (Fig. 1). Unfortunately, she continued to decline and in May 2021 an MRI revealed further increase in tumor size (Fig. 1C).
Autopsy images from case 1. A, Posterior view of brain with arrow pointing to mass. B, Axial slice through pons showing right-sided infiltrating mass (glioblastoma).
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CN V, with extension into Meckel cave (Fig. 2). CN III also appeared expanded and CN IV could not be identified.
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T1-weighted gadolinium contrasted magnetic resonance imaging axial plan images from case 2 before (A) and 8 (B) and (C) 15 months after conventionally fractionated radiation therapy.
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MRI demonstrated an enhancing mass centered in left Meckel cave that was new in comparison to a scan from 2 years prior (Fig. 3A). MRI showed a marked interval increase in size of her left-sided tumor with further extension into the left cavernous sinus, foramina ovale and rotundum, pterygopalatine fossa, and petrous apex (Fig. 3B). It now had thick peripheral rim enhancement and central necrosis (Fig. 3C).