ntuh neurosurgery morning meeting case discussion date: 2015/04/21 presented by pgy 何御彰
TRANSCRIPT
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