PMC5339913_01
(a) A gadolinium-enhanced T1-weighted magnetic resonance (Gd-T1WI MR) image taken before scheduled surgery revealed the contrasted mass lesion on the left calvarium adjacent to normal brain with subdural invasion. (b) Head computed tomography (CT) taken on the day of admission revealed right-sided acute subdural hematoma (SDH). (c) Head CT performed before the urgent surgery revealed acute SDH with midline shift that indicated intratumoral hemorrhage of the calvarial metastasis. (d) Postoperative head CT showed the resected calvarial tumor and improvement of the midline shift
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F1
Because of the recurrence of the skull metastasis, another surgical resection was planned [Figure 1a]. Head computed tomography (CT) revealed a right acute SDH adjacent to the tumor [Figure 1b]. Head CT showed an increase in hematoma size and exacerbation of the midline shift [Figure 1c]. Therefore, the removal of the SDH and tumor resection were performed emergently, with subsequent improvement of headache and motor weakness [Figure 1d].
(a) Intraoperative findings included subdural tumor progression and SDH adjacent to the tumor. (b) Low-power magnification of a hematoxylin and eosin-stained section. Tumor (arrow head) invasion to the dura mater (*) and hemorrhage (arrow) were observed
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F2
There was no apparent adhesion of the lesion to normal brain tissue [Figure 2a]. The histological diagnosis was metastatic chondrosarcoma [Figure 2b].