PMC7294173_01
Preoperative neuroradiological studies. (A) Computed tomography scan showing an isodense 3-cm-parietal mass with surrounding digitiform edema, (B) preoperative magnetic resonance imaging (MRI). (B1) T2-weighted MRI showing a hyperintense lesion with significant perilesional edema, (B2) diffusion-weighted imaging MRI showing a bright signal within the lesion (restriction of water diffusion), (B3) low apparent diffusion coefficient value within the lesion fluid. (B4) MR spectroscopy showing a high lipid level (lip) and decreased N-acetylaspartate, (B5) gadolinium- enhanced T1-weighted MRI showing a low-intensity lesion with rim enhancement which extended to the subarachnoid space (arrow).
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F1
An urgent brain computed tomography (CT) scan demonstrated an expansive process in the right parietal lobe [Figure 1a]. For better characterization a magnetic resonance imaging (MRI) was also performed, revealing a cystic cortico-subcortical lesion [Figure 1b].
Intraoperative photographs. (A) The patient was placed in the lateral position, (B) following dura opening, a swollen brain was found with a whitish subarachnoid area (arrow), (C) a catheter was inserted at the point where the abscess capsule was closest to the cortex. Brownish liquid pus was aspirated for mass decompression and later microbiological study. (D) Surgical view following removal of the whitish subarachnoid area and cavity washing.
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F2
After opening the dura mater, a swollen brain was found [Figure 2].
Postoperative magnetic resonance imaging (MRI) studies. Follow-up T2-weighted and gadolinium-enhanced T1-weighted MRI demonstrated progressive brain edema reduction, shrinkage of the residual cavity, and disappearance of contrast enhancement areas.
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F3
Follow-up MRIs demonstrated favorable progress without any radiological suspicion of recurrence [Figure 3].