PMC7395469_01
Preoperative MRI. (a) T2-weighted image, sagittal plane. Tumor of 14 x 10 x 6 mm in size in the caudal dorsal medulla and upper cervical cord (hypertensive signal). (b) T2-weighted image, axial plane. The tumor on the right side of the medulla has similar characteristics. (c) Contrast enhancement axial T1. No contrast enhancement in this lesion.
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F1
MRI examination detected an intramedullary lesion located at the upper cervical (C0-C1) level on the right side; there was no evidence of any neurovascular conflict or other relevant findings [Figures 1-3].
Preoperative MRI at the level of the cisternal part of the trigeminal nerves in CISS sequence. (a) Axial plane. (b) Sagittal plane. (c) Coronal plane. MRI demonstrates no signs of vascular conflict.
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F2
MRI examination detected an intramedullary lesion located at the upper cervical (C0-C1) level on the right side; there was no evidence of any neurovascular conflict or other relevant findings [Figures 1-3].
Preoperative MRI at the level of the cisternal part of the trigeminal nerves. (a) T1 with contrast enhancement, axial plane. The focus of homogeneous enhancement is in the cisternal part of the root that related to the stereotaxic surgery procedure that affected that area. (b) DTI sequence. Anisotropy fraction is 463 at the TREZ level.
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F3
MRI examination detected an intramedullary lesion located at the upper cervical (C0-C1) level on the right side; there was no evidence of any neurovascular conflict or other relevant findings [Figures 1-3].
Intraoperative image. The tumor has glial signs, soft density, and no clear borders from normal tissue.
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F4
Intraoperatively, the tumor was tan in color without clear borders of separation it from the normal tissue [Figure 4].
Postoperative MRI. (a) T2-weighted image, sagittal plane. Postoperative cavity and perifocal edema of the medulla and spinal cord. Subcutaneous postoperative edema of the soft tissues. (b) T2-weighted image, axial plane. The mass was resected, the same postsurgical changes. (c) Contrast enhancement axial T1. A small amount of contrast enhancement presents in the surgical field.
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F5
The resection was determined as subtotal [Figure 5].
Histological examination. (a) H&E staining of the tumor, x100. The sample contains rare ovoid cells with well-shaped processes as well as the sings of edema single fibers and glia cells. The neurons are often separated in a diffuse way. (b) NeuN staining, x100. Positive staining. (c) Synaptophysin staining, x100. Positive staining.
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Immunohistochemical study of the surgical specimen defined the tumor as ganglioglioma, Grade I [Figure 6].
Postoperative MRI in 24 months. (a) T2-weighted image, axial plane. No sign of tumor. (b) Contrast enhancement axial T1. No contrast enhancement at the level of the spinal cord.
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F7
Twenty-four-month follow-up showed no evidence of tumor persistence or recurrence on MRI [Figure 7] and the facial pain did not return.