Mark Hornyak, MD

This is a 69 year old male with a known history of renal cell carcinoma who presented with cognitive decline and a neck mass.He had memory issues which were attributed to chemotherapy. He also was having new headaches. The neck mass was due to an infection. Neurologic examination was relatively unremarkable.

• All
• Pre-Op
• Intra-op
• Post-op

: An MRI of the brain performed 9 years prior to this presentation- axial T1 with contrast (left) and FLAIR (right) images show no abnormality. Compare with Figure 2.

MRI of the brain at presentation. Axial T1 with contrast (left) shows the brightly enhancing tumor in the right temporoparietal region. FLAIR images (right) show the white edema spreading out from the tumor (red arrow)

MRI. Coronal (left) and sagittal (right) T1 with contrast images showing the location of the tumor.

Image acquired from the intraoperative image-guidance system. It shows the operative plan (thin light-blue line) and precise location of surgical instrument (represented by thick dark-blue line) relative to the patient’s pre-op MRI.

Intraoperative video obtained through the surgical microscope. The tumor has been debulked and dissected free from the surrounding brain. Video shows the final removal of the tumor.

Intraoperative image showing the opening created in the surface of the brain (the corticotomy) and the underlying tumor resection cavity. Note the corticotomy measures only apx 10mm (1/2 inch) across, while the tumor measured 35mm (1 ½ inches).

: Immediate postoperative CT head. Bone algorithm (right) shows the craniotomy (opening in the skull) used to access the tumor, and the tissue protocol (left) shows the resection cavity with a small amount of blood layering dependently.

MRI of the brain 2 days after surgery. Axial T1 with contrast (left) shows resection of the tumor with small amount of blood within the resection cavity. FLAIR images (right) show persistant adjacent cerebral edema (red arrow)).

SRS planning images (merged CT & MRI) in the axial (left), coronal (middle) and, sagittal (right) planes with overlapping radiation dosing information. Note the conformity of the Stereotactic Radio Surgery (SRS) dose (demonstrated by the concentric rings around the tumor resection cavity) that treat the tumor bed without exposing the remainder of the brain to high doses of radiation.

MRI obtained 3 months postop. Axial T1 with contrast (left) shows resection of the tumor without residual or recurrent disease. FLAIR image (right) shows resolution of cerebral edema (Compare with Figures 2 and 8 – red arrows)

MRI obtained 3 months postop in coronal (left) and sagittal (right) planes further demonstrating resection of tumor.