NTUH NeurosurgeryMorning MeetingCase Discussion

Date: 2015/04/21Presented by PGY 何御彰

Basic profile

• Age: 40 y/o• Sex: Female• Diagnosis– Right temporal-parietal tumor, suspected high grade glioma

• Past history– Uterine myoma, status post myomectomy (2006/04/13)

History

• Chief complaint– Focal seizure affecting left upper limb with subsequent

weakness on 2015/03/30

• Present illness– 2015/03/30 Weakness in left upper limb without LOC

Cheng-Ching Hospital, Head CT Right temporal-parietal brain

tumor– 2015/04/07 Admission

Imaging study

Head CT (2015/03/30)

Imaging study

Brain MRI (2015/04/08) Brain MRI (2015/04/08)

Imaging study

Brain MRI (2015/04/08)Brain MRI (2015/04/08)

Imaging study

NE

• Consciousness– Clear and alert, E4M6V5

• Gait– Stable

• Cranial nerve– Normal

NE

5/5 5/5

5/55/5 5/5

5/55/5

5/55/5

5/55/5

++ ++

++ ++++ ++

++++

++++

↓ ↓

5/5

Operation (2015/04/09)

• Pre-operative diagnosis– Right temporal-parietal tumor, suspected high grade

glioma

• Operative method– Right fronto-temporal craniotomy

Operation (2015/04/09)

• Operative finding– A 5.0 x 5.5 x 4.0 cm, whitish-to-grayish, hypovascularized,

soft, fragile and ill-demarcated tumor mainly located over the right posterior frontal lobe (about pre-motor cortex region by intra-operative mapping)

– Intra-operative left hand and foot MEP decreased and even vanished several times. The left foot MEP recovered to the baseline and the left hand MEP decreased in the end of the operation

• Frozen– A glioma of at least WHO grade II is considered

Post-operative course

• Final pathology– Glioblastoma with oligodendroglioma component (WHO

grade IV)– p53 (+), IDH-1 (+)

• Consciousness– Clear and alert, E4M6V5

• Muscle power– Full

• Cranial nerve– Normal