PMC4663023_01
Axial gadolinium-enhanced T1-weighted (upper row) and fluid-attenuated inversion recovery (lower row) magnetic resonance (MR) images. A: Preoperative MR images showing a mild enhanced tumor with perifocal edema in the left temporal lobe and insula. B: Postoperative MR images depicting the implanted carmustine wafers (arrows) on the surface of the resection cavity. C: MR images obtained 5 months after the operation demonstrating no tumor recurrence. The edema surrounding the cavity had improved. The presence of carmustine wafers was not confirmed.
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F1
Magnetic resonance (MR) imaging revealed a slightly enhanced tumor with perifocal edema in the left temporal lobe and insula (Fig. 1A). Postoperative MR imaging revealed the presence of carmustine wafers on the surface of the resection cavity (Fig. 1B). The presence of carmustine wafers was not confirmed (Fig. 1C).
A, B: First intraoperative views after gross total removal of the tumor showing eight carmustine wafers implanted on the surface of tumor cavity adjacent to the left middle cerebral artery (M2 portion). The carmustine wafers were covered with absorbable hemostat (Surgicel , Ethicon Inc., Somerville, New Jersey, USA). C: Second intraoperative view after evacuation of hematoma in the resection cavity, corresponding to A, B, showing an aneurysm with a clot (arrow) at the M2 portion, running along the surface of the cavity.
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F2
After gross total resection of the tumor, eight carmustine wafers were placed on the surface of the tumor cavity adjacent to the left M2 portion of the middle cerebral artery (MCA) with interposition of absorbable hemostat (Surgicel , Ethicon Inc., Somerville, New Jersey, USA) (Fig. 2A, B). An aneurysm with a clot was observed at the M2 portion running along the surface of the cavity (Fig. 2C).
A: Computed tomography (CT) scan obtained 6 months after the initial operation revealing hemorrhage in the tumor cavity and subarachnoid hemorrhage. B: CT angiogram showing an aneurysm (arrow) at the M2 portion of the left middle cerebral artery.
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F3
Computed tomography (CT) revealed massive hemorrhage in the tumor cavity with subarachnoid hemorrhage (Fig. 3A). CT angiography revealed an aneurysm at the M2 portion of the left MCA (Fig. 3B).
A: Second intraoperative inspection found a dissection (arrow) in the intima of the M2 portion near the aneurysm. B: Histopathological examination of the excised tissue revealed ruptured pseudoaneurysm wall covered with clot. Hematoxylin and eosin (H.E) and Elastica van Gieson (EVG), original magnification x1 or x10.
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F4
Intraoperative inspection identified a dissection in the intima of the M2 portion near the aneurysm (Fig. 4A). Histopathological examination of the excised tissue revealed ruptured pseudoaneurysm wall covered with clot (Fig. 4B).