Board Certified Neurosurgeon Brain & Spine Care 860-889-9035
Mark Hornyak, MDBoard Certified Neurosurgeon
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Brain / Tumor Case

Brain Metastasis

69 year old man with known history of renal cell carcinoma presents with cognitive decline and neck mass. Memory issues were attributed to chemotherapy. Also was having new headaches. Neck mass was due to an infection. Neurologic examination was relatively unremarkable.

Description

69 year old man with known history of renal cell carcinoma presents with cognitive decline and neck mass. Memory issues were attributed to chemotherapy. Also was having new headaches. Neck mass was due to an infection. Neurologic examination was relatively unremarkable.

Gallery

Images

Figure 1An 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.
Figure 2MRI 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)
Figure 3: MRI. Coronal (left) and sagittal (right) T1 with contrast images showing the location of the tumor.
Figure 4Image 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.
Figure 5Intraoperative 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.
Figure 6Intraoperative image showing the opening created in the surface of the brain (the corticotomy ) and the underlying tumor resection cavity. Note the
Figure 7Immediate 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.
Figure 8MRI 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).
Figure 9MRI 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)
Figure 10MRI obtained 3 months postop in coronal (left) and sagittal (right) planes further demonstrating resection of tumor.

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