PMC9853524_01
Pre-op MRI scan with T1 post gad and T2 weighted images showing right sided heterogeneous intraventricular lesion with low T2 signal likely calcified components with some areas of avid gadolinium enhancement.
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F1
SEGA during investigation for migraine (Figure 1).
Pre-operative mapping and trajectory planning, Green - CST (cortico spinal tract), Blue - FAT, Magenta - Tumor.
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F2
Surgical resection was performed with pre-operative tractography and mapping (Figures 2A,B) A transsulcal minimally invasive parafascicular approach (tsMIPS) was carried out using NICO BrainPath system  with assistance of neuronavigation, 5-ALA, intraoperative neurophysiological monitoring (IONM), and intraoperative ultrasound.
Tumor showing part bright Fluorescence intraoperatively.
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F3
Intraoperatively, the tumor was found to have both bright and pale fluorescence under Blue 400 filter:Zeiss Pentero 900 (Carl Zeiss Meditec ), in the cystic and solid components respectively (Figures 3A,B).
Intraoperative US artefact caused by Residual intraventricular blood and calcified component.
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F4
No fluorescence was perceived at the end of resection (Figure 4).
3-Year Follow-up Postoperative MRI - Axial (A) - T1-Gad weighted, (B) - FLAIR and (C) - T2 weighted, Coronal (D) - T1-Gad weighted and Sagittal (E) - T1-Gad weighted) images showing near total resection with minor contrast enhancing in the lateral walls of the third ventricle and in the fornices. This is the last follow-up scan and the patient has not received further treatment apart from surgery.
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F5
Histology- Areas of epithelioid appearances with large vesicular nuclear and prominent nucleoli associated with abundant granular or ground glass cytoplasm, merged with spindle-shaped cells forming compact glial fibrillary background. Focal calcification visible, tumor also attached to ependymal cells.
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F6