PMC5858123_01
Magnetic resonance imaging T2 FLAIR 3D sequence, with DTI tractography fusion showing the relationship between the tumor and major brain tracts. The green trajectory of the biopsy avoids the corticospinal tract ending in the biopsy target. The yellow segment notes the extra depth (10 mm) of the infusion cannula tip.
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F1
A transcerebellar, transpeduncular frameless navigated biopsy was performed through a suboccipital entry point, using the Brainlab VarioGuide navigation system (Figure 1).
Magnetic resonance imaging T1 GE 3D axial sequence without intravenous contrast, immediately after virus infusion. The intraparenchymal injection of gadolinium before infusing the virus with the MEMS cannula (this cannula has two independent channels) is pushed out from the tumor as the virus is infused from a second channel.
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F2
An intraoperative MRI was performed immediately after DNX-2401 administration that showed no biopsy complications and gd diffusion through the tumor thereby confirming successful targeted delivery of the virus (Figure 2).
Diffuse midline glioma showing strong nuclear H3K27M mutant protein (immunohistochemistry, X200).
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F3
The pathologist later classified the tumor as a WHO grade II glioma with a H3.3 K27M mutation that was determined by Sanger sequencing (Figure 3).