PMC3214485_01
Preoperative picture of the patient showing a large right frontal swelling
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F1
A five-year-old boy presented with seven weeks' history of a progressive and painless swelling on the right side of the forehead and temporal region [Figure 1]. It was multinodular with cystic and solid components, not tender, but fixed to the underlying skull [Figure 1].
Preoperative contrast brain CT scan showing a huge extra axial tumor in the right fronto-temporal area, destroying the frontal bone with intra- and extracranial components. There is effacement of the ventricles
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F2
It had a central cystic component and a large right frontotemporal skull defect [Figure 2].
Intraoperative image of the patient. After removal of the pathological bone, cranioplasty with molded methyl methacrylate was carried out. The implant was kept in place with a Nylon 1 suture
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F3
The patient had a one-stage bifrontal craniectomy, with complete tumor excision, and frontal cranioplasty with antibiotic impregnated methyl methacrylate [Figure 3].
Photomicrograph of the excised tumor, showing neurofibroma composed of proliferating spindle-shaped cells, with dark nuclei, disposed in a loose myxoid background. The cells have wavy to comma-shaped nuclei and moderate cytoplasm. H and E stain, x400
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F4
The histology report was consistent with neurofibroma [Figure 4].
Postoperative contrast CT at eight weeks. There was reexpansion of the right frontal lobe
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F5
Brain C T scan at eight weeks post surgery showed no residual tumor [Figure 5].