PMC3867594_01
Axial contrast-enhanced T1-weighted MRIs. A) Preoperative image demonstrating a 6.5 x 5.5 cm heterogeneous mass in left parietal region. B) Postoperative MRI following gross total resection. C) Axial MRI 8 months postoperatively reveals recurrent tumor within the resection cavity of the initial tumor. D) MRI 4 months after a second craniotomy reveals progression of disease with numerous new small lesions along brain surface and cranial nerves, most notably in posterior fossa, periventricular region, and along the surgical cavity.
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T1-weighted head MRI (Figure 1A) showed a heterogeneous mass in the left frontoparietal region measuring 6.5 x 5.5 cm with areas of calcification and hydrocephalus. Gross total resection was achieved (Figure 1B). Routine 8-month surveillance MRI demonstrated an enhancing mass in the left parietal occipital surgical resection cavity measuring 3.8 cm in maximal diameter (Figure 1C). MRI revealed infiltrative tumor with diffuse leptomeningeal spread to intraventricular, supratentorial, and infratentorial locations, along with coating of multiple cranial nerves and nodular disease in the entire spine (Figure 1D).