PMC5820899_01
T1-weighted magnetic resonance images (a-c), T2-weighted magnetic resonance image (d), diffusion-weighted magnetic resonance imaging (e), postop magnetic resonance imaging (f)
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F1
T2-weighted MRI with hypointense zones, and it had a rim-like enhancement on T1-weighted images [Figure 1a-d]. The lesion was hypointense, except a hyperintense central zone corresponding to calcification on diffusion-weighted MRI [Figure 1e]. En bloc resection was accomplished through a left frontal craniotomy [Figure 1f].
Microscopic photography of pathologic specimen (a) H and E, x200, (b) H and E, x400
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F2
Prominent necrosis was present [Figure 2].
Surgery for the 1st recurrence (a and b), Gamma knife radiosurgery for the 2nd recurrence (c), surgery, (d and e) and Gamma knife radiosurgery for the 3rd recurrence (f) have been accomplished
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F3
She was readmitted to our clinic with a recurrent right hemiparesia 2 months postoperatively, after which a new recurrent lesion was identified on the new brain MRI [Figure 3a]. The tumor was resected through the same craniotomy side, and the pathology was compatible with the previous one [Figure 3b]. Stereotactic radiosurgery with Gamma-Knife (Elekta AB, Stockholm, Sweden) was conveyed at that time with a margin dose of 18 Gy (50% isodose line) [Figure 3c]. Her general status was well until 9 months after the first surgery [Figure 3d]. A third surgery was performed and a second Gamma-Knife radiosurgery (GKR) was given to the tumor bed (15 Gy, 50% isodose line) [Figure 3e and f].