PMC9699840_01
Follow-up MRI scans; white arrows indicate flow voids on the left side of the tumor corresponding to adjacent vessels: (a) initial MRI images obtained 3 years before bleeding. Tumor volume: 4.31 cm3, (b) second follow-up MRI images obtained 1 year before bleeding. Tumor volume: 12.76 cm3, (c) third follow-up MRI images obtained 2 months before bleeding. Adjacent blood vessels were stretched and moved to the left due to rapid tumor growth. Tumor volume: 21.67 cm3, and (d) fourth follow-up MRI images obtained 2 weeks before bleeding. Tumor volume: 22.27 cm3.
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F1
Furthermore, MRI revealed a left flow void showing blood vessels that had moved from the median side to the lateral side due to tumor growth [Figure 1].
Imaging at onset of bleeding: (a) the head CT images at onset of bleeding showed left acute subdural hematoma (ASDH), interhemispheric ASDH, and intracerebral hematoma extending from the left intra-/extra-tumoral lesion. (b) Enhanced CT showing extravasation (black arrow) in the hematoma of the left frontal lobe. (c) Left lateral DSA of the left CCA revealed neither tumor staining nor abnormal vessels. (d and e) The mass lesion on the MRI image shows a mixed signal intensity area on T2-weighted images.
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In the venous phase of the bilateral common carotid angiogram, the anterior part of the superior sagittal sinus (SSS) revealed no obliteration [Figure 2].
Postoperative imaging: (a) postoperative head CT images showing removal of the tumor and hematoma. (b) Enhanced MRI images showing gross total removal.
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F3
Postoperative enhanced MRI revealed gross total tumor removal [Figure 3].