PMC2840717_01
Preoperative sagittal precontrast (A) and postcontrast (B) MR images demonstrating an enhancing clival-based tumor with mass effect on the brainstem. Postoperative sagittal MR image (C) revealing resection of the mass. Preoperative CT scan (D) demonstrating tumor and bony erosion of the clivus and dens, and postoperative CT scan (E) showing removal of the tumor, dens, most of the body of C-2 and the inferior half of the clivus.
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C-2 (Fig. 1A and B). Computed tomography scanning showed that the mass had partially eroded the clivus and C-2 (Fig. 1D). Postoperative imaging demonstrated GTR (Fig. 1C and E).
Photomicrographs showing spindle and epithelioid tumor cells adjacent to bone (A), tumor cells with strong expression of cytokeratins (AE1.3, B), epithelial membrane antigen focally (C), and diffuse loss of nuclear INI1 expression in large neoplastic cells but retained expression in intratumor vasculature and lymphocytes (D). H & E (A), original magnification x 100.
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The pathology results indicated numerous rhabdoid cells with a mixture of neuroepithelial and mesenchymal components (Fig. 2A-C) and the loss of INI1 expression (Fig. 2D), consistent with an AT/RT.
Intraoperative and postoperative images showing the transoral approach to the clival mass (A), the mass itself (B), the anterior dura and ligaments (C), the resected tumor specimen (D), post-posterior fusion and alignment in the halo (E), and the anterior surgical incision 6 months after surgery (F).
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To assure adequate exposure a tracheostomy tube was placed, the patient's mandible was split, and his tongue was pushed inferiorly (Fig. 3A and B). The tumor was completely extradural and removed en bloc with complete preservation of neurological function and without CSF leakage (Fig. 3C and D). The patient was placed in a halo after the anterior procedure (Fig. 3E). Six months after surgery the patient's midline incision was barely noticeable (Fig. 3F).
Preoperative sagittal MR images, precontrast (A) and postcontrast (B), demonstrating an enhancing mass at L-1. Postoperative sagittal MR image (C) confirming resection of the mass.
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An MR image demonstrated no tumor at the site of the primary resection; however, an MR image of the lumbar spine revealed a 2-cm extramedullary mass filling the thecal sac at the L-1 level (Fig. 4A and B). T-12 to L-1, and the tumor was removed (Fig. 4C).