{"id":344591,"date":"2014-09-24T15:15:17","date_gmt":"2014-09-24T13:15:17","guid":{"rendered":"https:\/\/medizinonline.com\/multimodal-imaging-and-interhemispheric-resection\/"},"modified":"2014-09-24T15:15:17","modified_gmt":"2014-09-24T13:15:17","slug":"multimodal-imaging-and-interhemispheric-resection","status":"publish","type":"post","link":"https:\/\/medizinonline.com\/en\/multimodal-imaging-and-interhemispheric-resection\/","title":{"rendered":"Multimodal imaging and interhemispheric resection."},"content":{"rendered":"

Case report:<\/em> The 53-year-old, previously healthy woman was clarified by CT imaging due to a tripping fall with commotio. Here, no intracranial trauma sequelae were evident. However, a large right parieto-occipital mass was presented as an incidental finding, which was further characterized by MRI. Clinically neurologically our patient presented unremarkable.<\/strong><\/p>\n

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MRI diagnosis:<\/strong> T2 and FLAIR weighting reveals a 4\u00d75\u00d74 cm inhomogeneous hyperintense mass with cystic portions. In T1-weighted images after i.v. gadolinium administration, the hypointense mass shows no contrast enhancement (Fig.1) <\/strong>. Fiberoptic tract imaging (DTI) shows tumor-related displacement of visual radiation (Fig. 2a) <\/strong>without evidence of infiltration. 3D reconstruction of contrast-enhanced TOF angiography reveals no bridging veins relevant to an interhemispheric occipital access pathway (Fig. 2b)<\/strong>. 1-H spectroscopy shows a strong decrease of the physiological nerve cell marker NAA and a moderate increase of the proliferation marker choline by 55% compared with the opposite side. In addition, a lactate peak, the marker for anaerobic glycolysis, can be seen. The image morphologic aspect resembles an oligodendroglioma, and the spectrum is suggestive of a grade III tumor.<\/p>\n

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Surgery:<\/strong> To facilitate the surgical access route, our patient is positioned on the right side of the body. This causes a shift of the brain to the right, thus a traumatic brain retraction can be avoided (Fig. 3).<\/strong> After entering the interhemispheric space, the tumor is resected with endoscopic-assisted technique (Fig. 4). <\/strong>Using the neuroendoscope, the parts of the tumor that are not visible with the microscope can be viewed and removed. (Fig. 5a and b).<\/strong> Finally, resection control is performed with the aid of intraoperative MRI (iOP-Polstar). Contrast-enhanced T1-weighted sequence shows a suspicious approximately 0.5\u00d70.5 cm lesion at the right lateral resection margin. The tumor-suspected lesion is subsequently resected. Thus, complete tumor resection was achieved. Extubation of the patient from anesthesia was smooth. The histopathological diagnosis is ana-
\nplastic oligoastrocytoma.<\/p>\n

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Postoperative course: <\/strong>On the following day, complete resection of the tumor was documented by MRI (Fig. 6) <\/strong>. Postoperatively, there was a minimal visual field defect on the left side; at discharge, the manipulation-related symptoms had completely disappeared.<\/p>\n

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CONCLUSION: <\/strong>Using multimodality tools such as accurate neuroradiologic imaging, use of targeted neuroendoscopy, and intraoperative resection control by iOR-MRI, complete removal of difficult-to-access tumors can be achieved. In our particular case, interdisciplinary teamwork was crucial to therapeutic success.<\/p>\n","protected":false},"excerpt":{"rendered":"

Case report: The 53-year-old, previously healthy woman was clarified by CT imaging due to a tripping fall with commotio. Here, no intracranial trauma sequelae were evident. However, a large right…<\/p>\n","protected":false},"author":5,"featured_media":46819,"comment_status":"closed","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"pmpro_default_level":"","cat_1_feature_home_top":false,"cat_2_editor_pick":false,"csco_eyebrow_text":"Removal of a parieto-occipital tumor ","footnotes":""},"category":[11520,11363,11370,11548],"tags":[15786,50869,50863,50874],"powerkit_post_featured":[],"class_list":["post-344591","post","type-post","status-publish","format-standard","has-post-thumbnail","category-cases-en","category-neurology","category-oncology","category-rx-en","tag-case-report","tag-interhemispheric-resection","tag-multimodal-imaging","tag-parieto-occipital-tumor","pmpro-has-access"],"acf":[],"publishpress_future_action":{"enabled":false,"date":"2026-04-18 01:50:58","action":"change-status","newStatus":"draft","terms":[],"taxonomy":"category","extraData":[]},"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"wpml_current_locale":"en_US","wpml_translations":{"fr_FR":{"locale":"fr_FR","id":344557,"slug":"imagerie-multimodale-et-resection-interhemispherique","post_title":"Imagerie multimodale et r\u00e9section interh\u00e9misph\u00e9rique","href":"https:\/\/medizinonline.com\/fr\/imagerie-multimodale-et-resection-interhemispherique\/"},"it_IT":{"locale":"it_IT","id":344576,"slug":"imaging-multimodale-e-resezione-interemisferica","post_title":"Imaging multimodale e resezione interemisferica","href":"https:\/\/medizinonline.com\/it\/imaging-multimodale-e-resezione-interemisferica\/"},"pt_PT":{"locale":"pt_PT","id":344590,"slug":"imagem-multimodal-e-resseccao-interhemisferica","post_title":"Imagem multimodal e ressec\u00e7\u00e3o interhemisf\u00e9rica","href":"https:\/\/medizinonline.com\/pt-pt\/imagem-multimodal-e-resseccao-interhemisferica\/"},"es_ES":{"locale":"es_ES","id":344599,"slug":"imagen-multimodal-y-reseccion-interhemisferica","post_title":"Imagen multimodal y resecci\u00f3n interhemisf\u00e9rica","href":"https:\/\/medizinonline.com\/es\/imagen-multimodal-y-reseccion-interhemisferica\/"}},"_links":{"self":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/344591","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/users\/5"}],"replies":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/comments?post=344591"}],"version-history":[{"count":0,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/posts\/344591\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media\/46819"}],"wp:attachment":[{"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/media?parent=344591"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/category?post=344591"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/tags?post=344591"},{"taxonomy":"powerkit_post_featured","embeddable":true,"href":"https:\/\/medizinonline.com\/en\/wp-json\/wp\/v2\/powerkit_post_featured?post=344591"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}