PMC9699865_01
Preoperative T2 FLAIR magnetic resonance imaging (MRI) scan in coronal (left) and sagittal (right) cuts. Tumor margins illustrated during preoperative planning in red. The tumor (red) is located in the supplementary motor area, with signs of extension to the cingulate gyrus. At the posterolateral border, tumor tractography shows corticospinal tract fibers (purple). (green: Brainstem, orange: Anterior commisure, yellow: Optic radiation).
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F1
The tumor mainly invaded the anatomical region of the supplementary motor area (SMA), extending inferiorly to the cingulate gyrus [Figure 1].
(a) Intraoperative ultrasound after dural opening. Hyperechoic lesion measuring 3 cm in depth. On the left, the falx is recognized by its bright white hyperechoic signal and its shape. (b) View of the posterolateral part of the resection cavity at the end of the operation. Hyperechoic residual tumor at 2 cm depth can be identified. At this area, subcortical stimulation identified the corticospinal tract.
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F2
On dura opening, tumor borders were identified with iUS [Figure 2a]. Final iUS, highlighted margins of resection, confirmed with image guidance [Figure 2b].
Postoperative (48-h) MRI scan T2 FLAIR (left) and T1+contrast (Right) sagittal sections, showing the resection cavity. Residual tumor can be seen at the posterolateral margins, where function was detected during subcortical stimulation.
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F3
Postoperative MRI confirmed 81% resection of the tumor (26.8 cm3 vs. 5.2 cm3) [Figure 3].