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Brain MRI performed 44 days post-operatively and overlying radiotherapy treatment plan. (A) MRI T1 pre-contrast. (B) MRI T1 post-contrast showing peripheral nodular enhancement on the left lateral and posterior surgical bed. (C) Gamma Knife (GK) radiosurgery treatment plan overlying T1 post-contrast MRI brain. The wide post-operative area is represented by the yellow contour. The pink contours delineate the three nodular, high-risk areas.
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The patient underwent GK to the tumor bed using a four-matrix paradigm: the broad, post-operative region was treated with 8 Gy to the 50% isodose line while three radiographically enhancing, nodular foci within this region were simultaneously treated with 20 Gy each to the 50% isodose line ( Figure 2 ).
Brain MRI performed 34 months after completion of radiotherapy treatment. (A) T1 pre-contrast (B) T1 post-contrast showing no areas of peripheral or nodular enhancement.
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The most recent brain MRI performed 34 months after completing the radiosurgery treatment course showed only expected gliosis, post-surgical changes, and no enhancing foci or evidence of recurrent tumor ( Figure 3 ).