PMC9853359_01
Pre-operative MRI Brain with gadolinium contrast in T1WI (A) axial, (B) coronal and (C) sagittal sections showing large heterogeneously enhancing right temporal lobe lesion with multiple cysts of variable size.
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The lesion had multiple cystic components with minimal vasogenic oedema [Fig. 1].
Pre-operative and Post-operative EEGs (A) Pre-operative EEG demonstrating right-sided delta slowing and centro-posterior slowing, which leads to a period of repetitive sharp wave activity over the right frontal regions. There is irregular periodic discharge from bilateral frontal poles. Right frontotemporal theta activity is seen, which then slows and generalises over the right side, (B) Exemplar region identified in the pre-operative EEG demonstrating interictal abnormalities, showing right frontal waves, (C) Post-operative EEG shows 5Hz theta activity develop over the right hemisphere, maximal in the temporal leads, gradually evolving and subsiding.
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These changes were consistent with a focal seizure disorder originating from the right anterior quadrant, suggesting the tumour was the most likely epileptogenic focus [Fig. 2]. Repeat EEG following surgery demonstrated theta activity in the right hemisphere, mainly in the temporal region [Fig. 2].
Histopathological slides of the tumour post resection, (A) showing Pilomyxoid astrocytoma, composed of monomorphous piloid cells separated by multiple microcystic spaces, (B) showing typical angiocentric arrangement (arrowed), (C) showing monomorphous bipolar tumour cells embedded in myxomatous stroma, (D) showing positive stain when tested with S100 stain.
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The MIB-1 (Ki-67) index was minimal at 2-3% [Fig. 3].
Comparison of intraoperative and follow up MRI findings with, (A) Intra-operative iMRI Brain with gadolinium contrast in T1WI axial section post tumour excision showing possible residual tumour in the superior medial aspect of the resection cavity on retrospective examination. (B) 3-month follow up MRI Brain with gadolinium contrast in T1WI axial section showing stable appearance of the residual tumour in the same location.
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The residual tumour also remained stable in size on follow-up MRI at three months [Fig. 4].