PMC3347491_01
(a) Sagittal head CT without contrast demonstrating predominantly cystic lesion in the right frontal lobe at time of trauma. (b) Pre-operative sagittal T1-weighted MRI with gadolinium contrast. (c) Axial T2-weighted MRI showing minimal edema. (d) Axial Diffusion-weighted imaging also showing lack of vasogenic edema
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F1
A non-contrast computed tomography (CT) scan was performed and revealed a hypodense lesion with hyperdense margins in the right frontal lobe [Figure 1a]. Magnetic resonance imaging (MRI) without gadolinium contrast showed a mass measuring 4.2 cm in greatest anterior-posterior x 3.2 cm in greatest transverse x 3.1 cm in cephalocaudal dimension, located in the right frontal lobe.(MRI with contrast was performed only after the delivery of the baby, see Figure 1b). No significant surrounding vasogenic edema was observed using T2-weighted and diffusion weighted imaging [Figure 1c and d].
(a) MRS of the brain lesion demonstrating choline and creatinine peaks, and a significant NAA peak. (b) Histology of excised tumor, (H and E, x400). The nuclei of the chondrocytes are small, have minimal atypia and no mitotic figures are seen
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F2
MRS showed significant N-acetylaspartate (NAA) peak in the lesion along with a choline peak (Ch) at 1804 of amplitude and creatine (Cr) peaking at 1122 [Figure 2a]. The intra-op fresh frozen sample of the brain lesion demonstrated cartilaginous tissue, which was later determined to be a parafalcine chondroma [Figure 2b].
Post-operative (1.5 year) sagittal T1-weighted MRI with gadolinium contrast
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F3
Post-surgical MRI with gadolinium was performed every 6 months and there was no evidence of any recurrence or residual of the neoplasm up until 1.5 years after surgical resection of the tumor. [Figure 3] The patient had no neurological deficits post-resection.