PMC7568113_01
Preoperative photograph demonstrating left eye ptosis and positioning for a left frontal craniotomy.
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F1
A 14-year-old male patient presented to the outpatient department with a 3-month history of painless proptosis of the left eye [Figure 1].
(a) Pre-operative CT brain with contrast axial sections demonstrating an anterior cranial fossa space occupying lesion with involvement of the orbital roof. There was a sclerotic contrast enhancing rim as well. (b) Preoperative CT brain with contrast sagittal sections demonstrating the lesion to be involving the orbital roof and causing mass effect and forward pushing the contents of the orbit. (c) Preoperative CT brain with contrast coronal sections through the orbit demonstrating the extent of the lesion to the midline and possible involvement of the cribriform plate.
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F2
CT scan of the head revealed a well-circumscribed lesion involving the left orbital roof and showing internal areas of calcification and sclerosis [Figure 2a-c].
Pre-operative MRI Brain without contrast, T2 weighted axial images (top and middle row), demonstrating the extra axial nature of the lesion and mass effect on the frontal lobes with midline shift towards the right. T1 weighted post contrast coronal images (bottom row) demonstrates areas of heterogenous enhancement.
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F3
It was extra-axial and exerting mass effect over the base of the left frontal lobe [Figure 3].
Post op CT head plain demonstrating interval resection of the lesion as well as the roof and medial wall of the orbit.
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F4
An immediate postoperative CT with contrast showed complete removal of the lesion as well as the roof of the orbit [Figure 4].
(a) Post-operative MRI Brain T1 post contrast axial section demonstrating interval resection of the lesion with resolution of mass effect and midline shift. (b) Post-operative MRI Brain post contrast FLAIR coronal images demonstrating the resection cavity extending to the midline.
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F5
Postoperative MRI brain with contrast [Figures 5a and b] demonstrates gross total resection.
Microphotograph demonstrating numerous small, round ossicles (psammomatoid bodies) embedded in cellular fibrous stroma and within bony trabeculae.
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F6
Histopathology was finalized as juvenile psammomatous ossifying fibroma [Figure 6].
Follow up CT head at two years following surgery showed no evidence of recurrence.
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F7
Follow-up at 2 years with plain CT head showed no evidence of recurrence [Figure 7].