PMC8168792_01
Preoperative MR showing diffuse leptomeningeal thickening both supra and infratentorial and over the spinal canal up to C5, with great enhancement to contrast administration, with involvement of the basal cisterns (ambiens, interpeduncular, prepontine, sylvian, premedullary, and Magna).
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F1
C5, with great enhancement to contrast administration, with involvement in ambiens, interpeduncular, prepontine, sylvian, premedullary, and Magna cisterns. Cystic formation is also shown in the cranio-cervical union causing compression of the medullary bulb [Figure 1].
Intraoperative view, multiple adhesions to the thickened arachnoid with multiple nodules on its surface (a and b), the pia mater was thickened with the same characteristics of the arachnoid (c and d). Cerebellar tonsils were released with opening of the medullary velum until the IV ventricle was identified, Firm adhesions are observed on emergence of both accessory nerves as well as bilateral IX, X, XI, XII, and PICA (e and f).
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F2
Firm adhesions are observed on emergence of both accessory nerves as well as bilateral IX, X, XI, XII, and PICA [Figure 2].
A multinucleated giant cell with two spherical structures that have a clear mucoide capsule (halos) surrounding a central pale nucleus. H&E x40 (a). Numerous spherical organisms that have a thick clear capsule and are surrounded by histiocytes forming a granuloma. H&E (x40) (b).
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F3
The histopathology revealed numerous spherical organisms that have a thick clear capsule and are surrounded by histiocytes forming a granuloma, multinucleated giant cells with spherical structures that have a clear mucoide capsule surrounding a central pale nucleus compatible with Cryptococcus [Figure 3].