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Embryonal tumor with multilayered rosettes (ETMR), C19MC-altered is a newly designated entity of the embryonal tumors of the central nervous system (CNS) according to the 2016 WHO classification system of CNS. Characteristically, these tumors are newly defined based on their specific molecular genetic amplification in chromosome 19q13.42 found at locus C19MC. To the best of our knowledge, we present the first reported case of ETMR in Saudi Arabian pediatric population. A 2-year-old boy presented to the hospital with generalized tonic-colonic seizure, vomiting, irritability, and inability to walk. Computed tomography (CT) scan showed a large left thalamic supratentorial brain tumor. The tumor measured 6.1 × 5.6 × 5.6 cm and was characterized by cystic changes, prominent vasculature, and calcifications. Histopathology, immunohistochemistry examination, and fluorescence in situ hybridization (FISH) analysis confirmed the diagnosis of ETMR. In addition to reporting this rare case, we provide a brief literature review, treatment options, patient outcome, and disease prognosis.

Background: Hemorrhages in the surgical cavity post resection of tumor aren’t uncommon and neurosurgeons are well versed with this entity, however occurrence of an Extra Dural Hematoma(EDH), that too at a site remote to the surgical cavity, is rare. The study presents 3 cases of post operative remote site EDH after tumor resection with review of literature and an attempt to define and discuss the variables which play a role in determining the occurrence, extent and prognosis of the same. Methods: The study investigated 601 patients who underwent tumor resection in the Department of Neurosurgery, Dr D Y Patil Hospital, from January 2017 to December 2019. All patients had a normal coagulation profile preoperatively. Postoperative remote EDH occurred in 3 patients whose data was examined closely in terms of age, sex, location, final diagnosis and treatment. Results: Of the 601 patients who underwent tumor resection from Jan 2017 to Dec 2019, a total of 3 patients in our study were found to have a post-operative remote site EDH. Two of these patients were male and 1 female. The age range was 35 to 46 years with a mean of 41 years. Neither did any of these patients have a pre-existing hydrocephalus nor were they subjected to a CSF diversion procedure preoperatively. All 3 patients developed EDH on the ipsilateral side wherein 2 of our patients had a hematoma in the ipsilateral frontal region anterior to the surgical cavity while 1 patient developed hematoma in ipsilateral parietal region posterior to surgical cavity. Hematomas were unilateral with no extension to opposite side. Two patients had to be re-operated in an emergency setting while one patient was conservatively managed. Conclusion: In patients with an expected volume loss via large tumor size, excess blood and CSF loss and a large craniotomy, remote EDH may develop and the neurosurgeon must have a high index of suspicion for this entity

BACKGROUND AND PURPOSE: Synthetic MRI enables the generation of various contrast-weighted images and quantitative data in a reasonable scanning time. We aimed to use synthetic MRI to assess the detection and underlying tissue characteristics of focal areas of signal intensity and normal-appearing brain parenchyma and morphometric alterations in the brains of patients with neurofibromatosis type 1. MATERIALS AND METHODS: Conventional MR imaging and synthetic MRI were prospectively obtained from 19 patients with neurofibromatosis type 1 and 18 healthy controls. Two neuroradiologists independently evaluated focal areas of signal intensity on both conventional MR imaging and synthetic MRI. Additionally, automatically segmented volume calculations of the brain in both groups and quantitative analysis of myelin, including the focal areas of signal intensity and normal-appearing brain parenchyma, of patients with neurofibromatosis type 1 were performed using synthetic MRI. RESULTS: The comparison of conventional MR imaging and synthetic MRI showed good correlation in the supratentorial region of the brain (κ = 0.82–1). Automatically segmented brain parenchymal volume, intracranial volume, and GM volumes were significantly increased in the patients with neurofibromatosis type 1 (P

BACKGROUND Brain tumours represents 1.7 % of all cancers and contributes 1.8 % of all cancer deaths. Of all the brain tumours, 80 % are supratentorial.1 Magnetic resonance imaging (MRI) is an important modality, having higher sensitivity for detecting intracranial pathology. Multiplanar imaging is possible with MRI which helps in detection, localization and characterization of the lesion. MRI examination has helped in early diagnosis, accurate localization of the tumour, with prompt initiation of appropriate medical or surgical therapy. Recent advances like magnetic resonance (MR) spectroscopy, MR fluoroscopy with stereotactic guided biopsy have revolutionized the role of MRI in study of intracranial tumours. METHODS A cross sectional study of 75 patients was done by Siemens Essenza 1.5T MRI from June 2018 to June 2020 using dedicated head coil. RESULTS In our study, most of the patients were between 31 - 60 years of age (39 % of all patients) with the largest group between 31 - 40 years (20 % of all patients). Out of 75 cases of supratentorial neoplasms, 47 (72 %) were intra-axial lesions, 15 (23 %) were extra-axial lesions and 3 (5 %) were intra ventricular lesions. In this study, 69 % of the lesions were solitary and 31 % were multiple. Most of patients (89 %) showed some enhancement, most common being heterogeneous/inhomogeneous enhancement. Commonest type of supratentorial neoplasms were metastases comprising 29 % of this study. CONCLUSIONS Magnetic resonance imaging is an important modality, having higher sensitivity for detecting intracranial pathology. Multiplanar imaging is possible with MRI which helps in early detection, localization and characterization of the lesion. Metastasis is the most common supratentorial tumour in this study followed by meningioma. Intra-axial tumours are more common than extra-axial tumours in this study. KEYWORDS MRI, Metastasis, Glioma, Meningioma

Background. Linguistic impairment following cerebellar lesions is characterized by a marked cerebellocerebral diaschisis with decreased perfusion in the left cerebral hemisphere. Case. We report on a 60-year-old right-handed French chef who presented with linguistic deficits following a right cerebellar infarction. Neurolinguistic examinations in the acute phase showed impaired graphomotor planning, especially for kanji (Japanese morphograms). Despite the absence of any structural damage to the supratentorial brain regions, a quantitative 123I-IMP SPECT study revealed a relative hypoperfusion, mainly around the left posterior middle temporal gyrus, considered to be a crossed cerebellar-cerebral diaschisis. We performed functional near-infrared spectroscopy (fNIRS) and observed that a picture card task could increase blood perfusion in the affected area. This task was as follows: once he saw a picture card depicting a dish, the patient had to list the ingredients that make up the dish. For example, he had to name vegetables, meat, and spices upon seeing a “curry” picture card. We added this task to his daily speech-hearing therapy regimen. In the chronic phase, we confirmed symptom amelioration in linguistic performance-paralleled reduction in the level of hypoperfusion on SPECT study. Discussion. This case is the first report of an fNIRS approach used to evaluate evidence-based prospective speech-hearing tasks by observing blood flow to the hypoperfused area of the cerebral cortex surface.

OBJECTIVE Acute subdural hematoma (ASDH) is a major cause of mortality and morbidity after traumatic brain injury (TBI). Surgical evacuation is the mainstay of treatment in patients with altered neurological status or significant mass effect. Nevertheless, concerns regarding surgical indication still persist. Given that clinicians often make therapeutic decisions on the basis of their prognosis assessment, to accurately evaluate the prognosis is of great significance. Unfortunately, there is a lack of specific and reliable prognostic models. In addition, the interdependence of certain well-known predictive variables usually employed to guide surgical decision-making in ASDH has been proven. Because gray matter and white matter are highly susceptible to secondary insults during the early phase after TBI, the authors aimed to assess the extent of these secondary insults with a brain parenchyma densitometric quantitative CT analysis and to evaluate its prognostic capacity. METHODS The authors performed a retrospective analysis among their prospectively collected cohort of patients with moderate to severe TBI. Patients with surgically evacuated, isolated, unilateral ASDH admitted between 2010 and 2017 were selected. Thirty-nine patients were included. For each patient, brain parenchyma density in Hounsfield units (HUs) was measured in 10 selected slices from the supratentorial region. In each slice, different regions of interest (ROIs), including and excluding the cortical parenchyma, were defined. The injured hemisphere, the contralateral hemisphere, and the absolute differences between them were analyzed. The outcome was evaluated using the Glasgow Outcome Scale–Extended at 1 year after TBI. RESULTS Fifteen patients (38.5%) had a favorable outcome. Collected demographic, clinical, and radiographic data did not show significant differences between favorable and unfavorable outcomes. In contrast, the densitometric analysis demonstrated that greater absolute differences between both hemispheres were associated with poor outcome. These differences were detected along the supratentorial region, but were greater at the high convexity level. Moreover, these HU differences were far more marked at the cortical parenchyma. It was also detected that these differences were more prone to ischemic and/or edematous insults than to hyperemic changes. Age was significantly correlated with the side-to-side HU differences in patients with unfavorable outcome. CONCLUSIONS The densitometric analysis is a promising prognostic tool in patients diagnosed with ASDH. The supplementary prognostic information provided by the densitometric analysis should be evaluated in future studies.

Objectives This study aims to analyze lesions on computed tomography (CT) images and digital subtraction angiography (DSA) of ruptured cerebral arteriovenous malformation (AVM). Methods Cross-sectional description of 82 patients' cerebral bleeding due to rupture of AVM, determined by multislice computed tomography or cerebral DSA at Bach Mai Hospital. Results Patients with ruptured AVM are commonly under 40 years old (62.2%), average age: 35.1 ± 11.2. On CT or DSA images, it is common to see AVM rupture causing cerebral bleeding in the supratentorial region (91.5%), with 83% cerebral lobe bleeding, mainly small and moderate hematoma volume ( p p Conclusions On MSCT and DSA images, ruptured AVMs often cause lobar hemorrhage in young people. AVMs are usually small to moderate in size. The feeding arteries are mainly derived from middle and posterior cerebral arteries, and drained mainly by superficial veins. The Spetzler–Martin classification and the supplementary grading scales are used for ranking the severity of the lesion, as well as for choosing AVM treatment options and assessing the prognosis.

Primary CNS lymphoma (PCNSL) is rare malignant B cell lymphoid tumor of brain which predominantly occurs in supratentorial region in periventricular location. Majority of PCNSL are of DLBCL type and idiopathic in etiology. Here we are reporting a case of primary CNS lymphoma, DLBCL involving extremely uncommon intraventricular location. Central neurocytoma, subependymal giant cell astrocytoma, choroid plexus tumors and meningiomas are the common diagnosis at this site. Aim of reporting this case is to bring awareness of unusual intraventricular location of primary CNS lymphoma which should be kept in mind before considering gross total excision of lesion.

Brain tumours may cause disturbances of cerebral auto-regulation & the blood brain barrier (BBB). These effects could possibly have an unfavourable influence on brain condition. To compare the effects of the application of a bolus hypertonic saline with those of mannitol on intraoperative brain relaxation. Ninety patients of ASA grade II and III in the age group >18 years with supratentorial brain tumours posted for elective brain tumour surgery were studied in the current study. They were randomly allocated into two groups. Each group enrolled with 45 patients- Group HTS : receiving 160 ml of 3% hypertonic saline. Group M : receiving 150 ml of 20% mannitol. Patients from both groups were induced with injection fentanyl, propofol & rocuronium. Maintained with N2O: O2 in a ratio of 2:1 combined with isoflurane, fentanyl and vecuronium. End tidal Co2 pressure were maintained between 35-40 mm Hg. Arterial blood pressure were kept within baseline value ± 20. Hence application of hypertonic saline is a more effective method for brain relaxation in patients posted for elective supratentorial brain tumours surgery and can be a great value in routine practice.

Cryptococcal meningitis is the most common intracranial infectious fungal disease. After a period of antifungal treatment, as the number of cells in the cerebrospinal fluid decreases, the biochemical indexes improve and the number of cryptococcus reduces, the patient’s condition suddenly worsen. Most of the symptoms are severe headache, raised intracranial pressure, together with impaired clinical nerve function. These presentations are often mistaken for a failure of antifungal treatment. In fact it’s an encephalitis syndrome which is unrecognized by most clinicians: Immune reconstitution inflammatory syndrome (IRIS). To increase awareness we retrospectively analyzed clinical data of 100 cases of cryptococcal neoformans meningitis, among which 26 patients develop CM-IRIS. All patients have been divided into three groups: Group 1, patients who were not treated with glucocorticoid and didn’t experienced IRIS; Group 2, patients who were not treated with glucocorticoid although developed CM-IRIS; Group 3, patients started treatment with glucocorticoid for two weeks with new onset CM-IRIS. Compared with the group treated with glucocorticoid, treatment without glucocorticoid was subjected to a higher risk of incident IRIS. The difference was statistically significant (P

Background: In patients with lesions located around or within eloquent motor or speech cortex, surgical resection is a challenge; because of high risk of development of postoperative deficits and incomplete resection. intraoperative neurophysiological monitoring (IONM) paves the way to complete resection in these patients along with functional preservation postoperative. Aim of the study: To assess the utility and effectiveness of IONM techniques in resection of lesions located in eloquent motor speech cortex (intrinsic brain tumors and epileptic zones), regarding the extent of resection and functional preservation postoperative. Patients and Methods: we conducted prospective observationalstudy on 30 patients with different types of lesions located within eloquent motor or speech cortex, by the use of low frequency direct cortical and subcortical stimulation technique,12 patients were operated under general anaesthesia and 18 patients were operated by awake craniotomy technique.All patients were assessed clinically and do MRI brain with contrast and FLAIR study postoperatively, those who developed new onset neurological deficits were assessed at 3months postoperative. Results: complete resection was achieved in 17 patients (56.6%). Immediate postoperative new onset or worsened neurological deficits were encountered in 18 patients (60%), however 3 months postoperative the deficits were persistent only in 4 patients (13.3%). Conclusion: direct cortical stimulation is an easy safe and reliablemethod for detection of cortical and subcortical functionally eloquent structures during resection of brain tumors and epileptic lesions

Dysembryoplastic neuroepithelial tumor (DNT) considered as a benign cortical glioneuronal neoplasm of children or young adults, typically present with drug-resistant focal epilepsy. DNTs are usually located in the temporal lobe but can found in any part of the supratentorial brain cortex. Multifocal DNTs have rarely reported. Here we present an eight years old boy with two years follow up, having a somewhat stable diffuse multinodular DNT of the most significant spatial extent that may have reported, involving cortical and subcortical left temporo-occipital lobe, bilateral basal ganglia and thalamus, presenting with headache, short stature, and behavioral disorder.

The most severe form of profound asphyxia in neonates is now known as “total brain injury,” which forms part of the clinical spectrum of hypoxic-ischemic encephalopathy (HIE). Although the magnetic resonance (MR) imaging features of total brain injury remain to be determined, a widespread hyperintensity of the supratentorial brain, known as the “white cerebrum sign,” has been reported in diffusion-weighted images (DWI). We examined four neonates who developed severe profound asphyxia. In the first week of life, all neonates showed the white cerebrum sign on DWI. A follow-up of these cases over a period of 1 month revealed diffuse bilateral multicystic encephalomalacia (MCE) as well as shrinkage of the basal ganglia and thalami (BG/T). These MR findings were common to all neonates, and all the neonates had severe adverse clinical outcomes. Neonates, who exhibit the white cerebrum sign on MR imaging due to profound asphyxia, develop major disabilities, and MCE with shrinkage of the BG/T suggests miserable outcomes.

Introducción: Los cavernomas son malformaciones vasculares de bajo flujo que ocurren principalmente en el cerebro y, menos frecuentemente, en la médula espinal. Son lesiones raras y representan alrededor del 5-13% de las malformaciones vasculares del sistema nervioso central. Objetivos: Evaluar el seguimiento de 30 casos de pacientes diagnosticados con cavernomas y describir los hallazgos clínicos, epidemiológicos, topográficos, evolutivos y la conducta terapéutica en un período de 22 años. Metodología: Se trata de un estudio observacional, transversal, de carácter cuantitativo, que incluye pacientes diagnosticados con cavernomas, a través de la recolección de datos en los Servicios de Neurocirugía de varios Hospitales de João Pessoa, Paraíba, y que requirieron abordaje clínico o quirúrgico durante el período comprendido entre 1995 y 2017. Resultados: Las manifestaciones clínicas más comunes fueron las crisis convulsivas en el 33,33% (n = 10), cefalea en un 20% (n = 6) y parálisis del nervio craneal en un 20% (n = 6). En cuanto al sexo, 63,33% (n = 19) fueron del sexo femenino y 36,66% (n = 11) del sexo masculino. En cuanto a la localización, predominó la región supratentorial (70,73%), siendo el lóbulo frontal el más acometido (41,46%). Las lesiones múltiples ocurrieron en tres casos, siendo dos de ellos confirmados de cavernoma familiar. De los 30 pacientes, 12 fueron sometidos a cirugía, por presencia de sintomatología importante o de complicaciones. Se produjo un fallecimiento debido a hematoma subdural agudo. Conclusión: Los cavernomas generalmente tienen evolución benigna, necesitando tratamiento quirúrgico sólo en los casos sintomáticos y ante la presencia de complicaciones. El seguimiento reveló una buena evolución del cuadro, siendo la mayoría de los pacientes asintomáticos o con síntomas controlados mediante medicación.

Background: Postoperative nausea and vomiting (PONV), and shivering are common general anesthesia complications. Hence, this study evaluates the effect of dexmedetomidine, given as a premedication, on PONV and shivering in patients with opium use who underwent elective supratentorial brain tumor surgeries. Materials and Methods: In a randomized clinical trial, 100 opium user patients who were candidates for elective supra-tentorial brain tumor surgery under general anesthesia were studied in two groups of 50 patients. The intervention group received dexmedetomidine (within 10 and 30 minutes infusion) before the anesthesia induction. Group placebo that received normal saline as a group. PONV and shivering rates were compared between the two groups. Results: Both groups did not differ in hemodynamic parameters during operation, including pulse rate, systolic and diastolic blood pressure, and anesthesia duration. In the dexmedetomidine group, patients suffered less from PONV and shivering rather than controls, and these differences were both significant (P=0.001 and P=0.027, respectively). Discussion: Dexmedetomidine administration before major surgeries might reduce post-operative nausea and vomiting and the occurrence of shivering, particularly in opium-addicted patients.[GMJ.2021;10:e2146]

Cerebral cavernous malformation (CCM) is a developmental abnormality of blood vessels that supply the brain. It is composed of large, adjacent capillaries which contain little or no neural tissue. They mostly occur in the supratentorial region. However, the occurrence of these vascular lesions can be seen at different sites of the central nervous system (CNS). The prevalence of CCM is estimated to be 0.4% in the general population and among the affected patients, 18.7% have multiple lesions. However, about 30-50% of CCM cases are asymptomatic and are found incidentally. Here we report a case of an eight-year-old girl with a massive hemorrhagic presentation of a left parietooccipital CCM.

Hemangioblastomas (HBLs) are highly vascular and cystic benign neoplasms. They form very small part of intracranial tumours and are often localized in the posterior fossa. Although most of them are sporadic, a significant group is accompanied with von Hippel-Lindau (VHL) syndrome. This case report presents a 57-year-old woman treated with total resection using micro-surgical technique and was diagnosed as HBL based on histopathologic findings. Contrast-enhanced cranial MRI of the patient with the complaints of spasms in the right side of body showed a right paracentral mass that caused midline shift. In literature, the previously reported cases of supratentorial HBL unaccompanied with VHL syndrome were searched in PUBMED, compiled and presented. It should be borne in mind that rare HBLs manifesting with various neurological symptoms may occur in the supratentorial region, and may not accompany with VHL syndrome.

Object To evaluate the efficacy and safety of trans-sulcal or fissure approach in surgical treatment of supratentorial lesions Study design Retrospective clinical case series Methods This study included 42 patients. Age ranged from 4 to 78 years. Sulcal dissection was done in 26 patients at or near the eloquent areas, and in 16 patients, it was done in non-eloquent areas. Diffusion tensor tractography, neuronavigation, and intraoperative monitoring were applied for lesions at the motor areas. The follow-up period was 24 months. Results Gross total excision could be achieved in 52% of patients. Sulcal dissection was easy in 26 patients with the lax brain. The outcome, according to the Karnofsky scale, was 100 in 21/42 (50%). Complications were transient deterioration of function in three patients, and immediate post-operative hemorrhage in two patients. Three patients became seizure-free after surgery. Conclusion The trans-sulcal dissection is a safe, useful, and applicable approach. Through which it is possible to reach deeply seated lesions. It preserves the motor functions, provides wider exposure, minimizes the need of brain retraction during surgery, and preserves the gyral layers. Complications are usually transient, specially in the presence of preoperative diffusion tensor tractography, intraoperative neuronavigation, and monitoring.

Introduction: Information on epidemiological profile of supratentorial tumors pathology is scant in developing countries like India hence; more institutional data are needed to know the tumor burden in pediatric population, to undertake necessary research and to improve the therapeutic modalities in any given locality. Aim: To study the distribution of various supratentorial tumors in pediatric age group according to age, sex, anatomical location and histological type and correlate findings from our institute with other institutional studies. Materials and Methods: We conducted a retrospective study to analyze the data on archived surgical samples of 45 pediatric patients (0-18 years) with supratentorial brain tumors, operated over a period of 10 years (January 2008 to December 2017). Data regarding age, gender, site of the tumor and histopathology were considered for the analysis. The results obtained were compared with the available published literature data matching to our study on Indian population. Results: The most common pediatric primary brain tumors occupying supratentorial region were astrocytic tumors (33.3%) followed by craniopharyngiomas (20%) and meningiomas (13.4%). The most common astrocytic tumor was pilocytic astrocytoma. Pediatric brain tumors were more common in males (60%) as compared to females (40%) with male to female ratio of 1.5: 1. Conclusion: Astrocytomas and craniopharyngiomas were observed to be the common supratentorial tumors among pediatric age group at our institute consistent with other multicentric studies conducted in India. Keywords: Astrocytoma, craniopharyngioma, Pediatric tumors, Supratentorium.

Background Congenital intracranial tumors are very rare and account for less than 2% of all childhood brain tumors. Teratomas constitute about one third to one half of these, predominantly located midline in the supratentorial region. Posterior fossa location rarely occurs and, based on the cases reported in the literature, commonly has a poor prognosis. Case presentation A newborn female, diagnosed prenatally with hydrocephalus, is presented at birth with increasing head circumference and Parinaud’s syndrome. Magnetic resonance imaging scans demonstrated a huge posterior fossa tumor with obstructive hydrocephalus. At surgery, through a suboccipital craniotomy, complete excision was achieved of a histological-proven immature teratoma. The infant received adjuvant chemotherapy for 1 year. She had normal neurological development and remained tumor-free through her 20-year follow-up. Conclusion The authors report this rare case of congenital posterior fossa teratoma with long-term outcome, and the literature is reviewed.

Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial brain tumor, which is usually diagnosed before the age of two and has a favorable prognosis. To date, only a few cases have been reported in the literature. We report a case of DIG in a three-month-old boy who presented to our pediatric emergency department with decreased activity and excessive crying. This case report highlights the computed tomography (CT) and magnetic resonance imaging (MRI) findings of this rare tumor. Non-contrast CT scan findings in our case initially masqueraded as an extra-axial arachnoid cyst; however, the MRI findings after contrast agent administration were typical for the diagnosis of DIG.

Background: Surgical treatment of brain tumors were proved to be at highest risk of unplanned reoperation. Therefore, we decided to find possible predictors of complications leading to early unplanned reoperations among patients with supratentorial brain tumors. Methods: We retrospectively analysed 328 patients who underwent craniotomy due to supratentorial brain tumor. Early reoperation was defined as reoperation during the same hospital stay. To determine the potential predictors of early reoperation we used univariate and multivariate logistic regression analyses. Results: A total of 22 (6.51%) patients underwent unplanned reoperation. Those patients significantly more often were diagnosed with high grade glioma (81.82% vs. 55.70%; p = 0.02). They had lower Red Blood Cells count (4.16 ± 0.82 vs. 4.60 ± 0.56 103/μl; p

Ganglioglioma is a benign slow-growing neoplasm that most frequently occurs at the supratentorial region. Nevertheless, there are occasional reports of ganglioglioma occurring in the brainstem and spinal cord. Here we report a rare case of the craniocervical ganglioglioma. A 3.5-year-old male, presented with severe progressive quadriparesis, gait disturbance, and sphincter deficit. Physical examination demonstrated the quadriparesis, associated with positive Hoffman, Babinski, and clonus signs, and increased respond of deep tendon reflexes. Magnetic resonance imaging (MRI) demonstrated an ill-defined mass within medulla and upper cervical spinal cord, which was hypo to iso signal on T1, heterogeneous iso to hypersignal on T2 and demonstrated marked bright enhancement on T1 with gadolinium (Gad) injection. On surgery, the mass had a soft texture, ill-defined border, and grey to brown appearance. According to the frozen section report, and due to the absence of the tumour-neural parenchymal interference, only decompression of the tumour and expansile duraplasty were performed. The histopathology revealed ganglioglioma. On last follow-up 14 months after surgery, the patient was asymptomatic and neurological status was improved. The craniocervical MRI demonstrated the tumour that did not grow. Although it is rare, the ganglioglioma should be in the differentiated diagnoses of tumours with compatible clinical and radiologic features even in the unusual locations, especially in the pediatric and young patients. Safety surgical resection should be considered in these patients, whenever possible. In the case of partial resection, that is common in the tumours located within functionally critical structures, long close follow-up rather than radiation therapy is required.

BACKGROUND AND PURPOSE: Acute cerebellitis is an acute neurologic condition attributable to a recent or concurrent infection or a recent vaccination or ingestion of medication, with MR imaging evidence of cerebellar edema. MR imaging can confirm an anatomic abnormality and may allow the radiologist to establish a differential diagnosis. The purpose of this research was to evaluate the MR imaging findings in children with acute cerebellitis due to infectious versus immune-related conditions, in particular whether MR imaging findings allow differentiation. MATERIALS AND METHODS: Electronic medical records were reviewed between 2003 and 2020 in our quaternary children’s hospital. Data included demographics and clinical records: presentation/symptoms, final diagnosis including acute cerebellitis and immune-related acute cerebellitis, length of stay, treatment, condition at discharge, and laboratory findings. Retrospective independent review of all brain MR imaging studies was performed. RESULTS: Forty-three patients (male/female ratio, 28:15) were included in this study. Average age at presentation was 7.08 years (range, 0.05–17.52 years). Thirty-five children had infectious and 8 children had immune-related acute cerebellitis. Significant differences in neuroimaging were the following: 1) T2-FLAIR hyperintense signal in the brainstem (37.50% versus 2.85%, P = .016); 2) T2-FLAIR hyperintense signal in the supratentorial brain higher in the immune-related group (37.50% versus 0.00%, P = .004); and 3) downward herniation, higher in the infectious acute cerebellitis group (42.85% versus 0.00%, P = .03). CONCLUSIONS: Acute cerebellitis is a rare condition, and MR imaging is helpful in the differential diagnosis. T2-FLAIR hyperintense signal in the brainstem and supratentorial brain may be indicative of immune-related acute cerebellitis, and downward herniation may be indicative of infectious acute cerebellitis.

Adult brain tumors mostly distinguish themselves from their pediatric counterparts. However, some typical pediatric brain tumors also occur in adults. The aim of this review is to describe the differences between classification, treatment, and outcome of medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adults and children. Medulloblastoma is a WHO IV posterior fossa tumor, divided into four different molecular subgroups, namely sonic hedgehog (SHH), wingless (WNT), Group 3, and Group 4. They show a different age-specific distribution, creating specific outcome patterns, with a 5-year overall survival of 25–83% in adults and 50–90% in children. Pilocytic astrocytoma, a WHO I tumor, mostly found in the supratentorial brain in adults, occurs in the cerebellum in children. Complete resection improves prognosis, and 5-year overall survival is around 85% in adults and >90% in children. Craniopharyngioma typically occurs in the sellar compartment leading to endocrine or visual field deficits by invasion of the surrounding structures. Treatment aims for a gross total resection in adults, while in children, preservation of the hypothalamus is of paramount importance to ensure endocrine development during puberty. Five-year overall survival is approximately 90%. Most treatment regimens for these tumors stem from pediatric trials and are translated to adults. Treatment is warranted in an interdisciplinary setting specialized in pediatric and adult brain tumors.

BACKGROUND AND PURPOSE: Definitions of fetal microcephaly and macrocephaly are debatable. A better understanding of their long-term prognoses would help guide parental education and counseling. This study aimed to explore the correlation between 2D and 3D fetal brain MR imaging biometry results and the long-term neurodevelopmental outcomes. MATERIALS AND METHODS: This analysis is a historical cohort study. Fetal brain biometry was measured on 2D and 3D MR imaging using a volumetric MR imaging semiautomated algorithm. We measured and assessed the following brain structures: the supratentorial brain volume and cerebellar volume and cerebellar volume/supratentorial brain volume ratio, in addition to commonly used 2D brain MR imaging biometric variables, including occipitofrontal diameter, biparietal diameter, and transcerebellar diameter. Microcephaly was defined as ≤ 3rd percentile; and macrocephaly, as ≥ 97th percentile, corresponding to −2 SDs and +2 SDs. The neurodevelopmental outcome of this study cohort was evaluated using the Vineland-II Adaptive Behavior Scales, and the measurements were correlated to the Vineland standard scores. RESULTS: A total of 70 fetuses were included. No significant correlation was observed between the Vineland scores and either the supratentorial brain volume, cerebellar volume, or supratentorial brain volume/cerebellar volume ratio in 3D or 2D MR imaging measurements, after correction for multiple comparisons. No differences were found among fetuses with macrocephaly, normocephaly, or microcephaly regarding the median Vineland standard scores. CONCLUSIONS: Provided there is normal brain structure on MR imaging, the developmental milestone achievements in early years are unrelated to 2D and 3D fetal brain MR imaging biometry, in the range of measurements depicted in this study.

BACKGROUND The authors investigated the incidence of ischemic lesions on immediate postoperative diffusion-weighted imaging (DWI) according to the findings of intraoperative motor evoked potential (MEP) and the correlation with postoperative motor function deficits. METHODS From January 2016 to June 2018, total 127 supratentorial brain tumor patients were enrolled in this study. The intraoperative MEP results were analyzed in the following three groups: no decline below 50 % of baseline (A), transient decline below 50 % of baseline (B), no recovery until end stage of surgery (C). Postoperative magnetic resonance imaging was performed within 48 hours after surgery. RESULTS Of the total 127 patients, MEP changes (group B&C) were observed in 25 patients (25/127, 19.7%), DWI positive findings were identified in 31 patients (31/127, 24.4%) and motor function deficits were observed in 19 patients (19/127, 15%), respectively. DWI positive finding rate was higher in gliomas (14/43, 32.6%) than meningiomas (8/51, 15.7%) or other tumors including metastasis (6/32, 18.8%), however, there was no statistical significance. In MEP changes, group B&C (16/25, 64%) showed higher DWI positive rate than group A (13/102, 12.7%). In DWI findings, the DWI positive cases (16/31, 51.6%) showed a higher motor function deficit rates than the DWI negative cases (3/96, 3%). These two results were all statistically significant (P CONCLUSIONS Both intraoperative MEP changes and postoperative DWI positive findings in supratentorial brain tumor surgery were significant related with postoperative motor function deficits. Even if intraoperative MEP changes occur during supratentorial brain tumor surgery, active and appropriate efforts to prevent irreversible MEP changes may reduce the occurrence of permanent postoperative motor function deficits.

The accurate recognition of multiple sclerosis (MS) lesions is challenged by the high sensitivity and imperfect specificity of MRI. To examine whether longitudinal changes in volume, surface area, 3-dimensional (3D) displacement (i.e. change in lesion position), and 3D deformation (i.e. change in lesion shape) could inform on the origin of supratentorial brain lesions, we prospectively enrolled 23 patients with MS and 11 patients with small vessel disease (SVD) and performed standardized 3-T 3D brain MRI studies. Bayesian linear mixed effects regression models were constructed to evaluate associations between changes in lesion morphology and disease state. A total of 248 MS and 157 SVD lesions were studied. Individual MS lesions demonstrated significant decreases in volume 3 (p = 0.04), greater shifts in 3D displacement by 23.4% with increasing duration between MRI time points (p = 0.007), and greater transitions to a more non-spherical shape (p 2.49 based on deviation from a perfect 3D sphere, a 92.7% in-sample and 91.2% out-of-sample accuracy was identified for the diagnosis of MS. Longitudinal 3D shape evolution and displacement characteristics may improve lesion classification, adding to MRI techniques aimed at improving lesion specificity.

Objective: Diagnosis of supratentorial space occupying lesion is a frequent dilemma in neurosurgical practice. MR spectroscopy that is an advanced MR imaging sequence can prove to be decisive in such cases. The objective of the study is to determine diagnostic accuracy of MRS in differentiating supra-tentorial brain space occupying lesions taking histopathology as gold standard Material and Methods: The cross sectional study was conducted at Department of Neurosurgery, Jinnah Postgraduate Medical Centre, Karachi from August 2018 to July 2019. A calculated sample size of 156 patients aged between 18-50 years after informed consent. All patients underwent MR Spectroscopy pre-operatively. Surgery was performed and histopathological findings were compared with spectroscopic findings. Results: The average age of the patients was 32.41 ± 10.02 years. There were 84 (53.84%) males and 72 (46.15%) females. The sensitivity of MRS was 90.69% with a specificity of 97.34%. Conclusion: MR Spectroscopy is an accurate diagnostic tool for establishing pre-operative differentiation between neoplastic and inflammatory lesion. It should be performed in all cases where contrast MRI is inconclusive in establishing the diagnosis. Keywords: , Brain Abscess, Supratentorial lesion, Brain Tumor

Developmental venous anomalies (DVAs) are extreme anatomical venous variations formed by multiple radiating medullary veins, which converge centripetally into a single collecting vein. Their coexistence with symptomatic cavernous malformations (CMs) has been reported in the literature. The aim of this study was to assess the characteristics of DVAs using MRI. A total of 6948 head MRIs of adult Caucasian patients were retrospectively analyzed to determine the number and locations of DVAs. We collected the data on the termination of the collecting vein, the prevalence of DVA-related CMs, and MRI FLAIR signal-hyperintensity corresponding to the location of the DVA. At least one DVA was identified in 7.46% of the patients. The prevalence decreased with age, with a Pearson correlation coefficient of − 0.7328. A total of 599 DVAs were identified. Multiple DVAs were found in 10.92% of the patients with DVAs. The DVAs were identified more often in the supratentorial region (73.12%, p

In general, Glioblastomas multiforme frequently occurs in supratentorial region but in less than 4% occur in the posterior fossa predominantly in the cerebellum, and spinal cords tumors represents 6% to 8% of all central nervous system tumors and spinal cord glioblastomas occur only in 1.5% of all spinal cords tumors. We presents two cases a male whit posterior fossa glioblastoma and a girl with spinal cord glioblastoma in both cases, MRI is the study of choice with high sensitivity and specificity for diagnosis, after that they underwent biopsy and the results of pathology described GBM in both cases. The treatment of election is radiotherapy plus chemotherapy and surge if is possible, the prognosis is poor even with treatment, thats is why we need to identify new therapeutic strategies; We currently believe it is necessary to use genetic platforms to identify possible therapeutic targets.

Introduction Young age is an adverse prognostic factor in children with ependymomas. Treatment of these infants is challenging since beneficial therapeutic options are limited. As ependymomas are considered a biologically heterogeneous group, we aimed to characterize infant ependymomas with regard to their histological and genetic features. Materials and methods We analyzed 28 ependymomas occurring in children younger than 18 months at diagnosis enrolled into the HIT2000-E protocols with the aim to postpone irradiation until the age of 18 months if possible. All cases underwent neuropathological review, including immunohistochemical characterization. Genome-wide copy number alterations (CNA) were assessed by molecular inversion probe assays, and RELA and YAP1 fusions were detected by RT-PCR and sequencing. Results All infant ependymomas were anaplastic (WHO grade III). Twenty-one (75%) cases were located in the posterior fossa. Gross total resection was accomplished in 12 (57%) of these cases. All posterior fossa tumors showed loss of H3-K27me3 characteristic of PFA ependymomas. CNA analysis showed a stable genome in all cases with lack of chromosome 1q gain, an adverse prognostic marker in PFA ependymomas of older children. However, after a median follow-up of 5.4 years, 15 (71%) relapsed, and 9 (43%) died. Seven ependymomas (25%) occurred in the supratentorial region. Gross total resection could be achieved in only two of these cases. Four tumors carried C11orf95-RELA fusions, and two cases had typical YAP1-MAMLD1 fusions (one case was not analyzable). The RELA-fused cases did not display CDKN2A loss as an adverse indicator of prognosis in this disease entity. Although three infants (43%) with supratentorial ependymomas relapsed, all patients survived (median follow-up, 8.0 years). Conclusion Infant ependymomas seem to fall into three biological entities, with supratentorial tumors carrying RELA or YAP fusions and PFA posterior fossa ependymomas. The latter showed a poor outcome even though chromosome 1q gain was absent.

Utilization of intraoperative neurophysiology (ION) to map and assess various functions during supratentorial brain tumor and epilepsy surgery is well documented and commonplace in the adult setting. The applicability has yet to be established in the pediatric age group. All pediatric supratentorial surgery utilizing ION of the motor system, completed over a period of 10 years, was analyzed retrospectively for the following variables: preoperative and postoperative motor deficits, extent of resection, sensory-motor mappability and monitorability, location of lesion, patient age, and monitoring alarms. Intraoperative findings were correlated with antecedent symptomatology as well as short- and long-term postoperative clinical outcome. The monitoring impact on surgical course was evaluated on a per-case basis. Data were analyzed for 57 patients (ages 3–207 months (93 ± 58)). Deep lesions (in proximity to the pyramidal fibers) constituted 15.7% of the total group, superficial lesions 47.4%, lesions with both deep and superficial components 31.5%, and ventricular 5.2%. Mapping of the motor cortex was significantly more successful using the short-train technique than Penfield’s technique (84% vs. 25% of trials, respectively), particularly in younger children. The youngest age at which motor mapping was successfully achieved was 3 vs. 93 months for each method, respectively. Preoperative motor strength was not associated with monitorability. Direct cortial motor evoked potential (dcMEP) was more sensitive than transcranial (tcMEP) in predicting postoperative motor decline. dcMEP decline was not associated with tumor grade or extent of resection (EOR); however, it was associated with lesion location and more prone to decline in deep locations. ION actively affected surgical decisions in several aspects, such as altering the corticectomy location and alarming due to a MEP decline. ION is applicable in the pediatric population with certain limitations, depending mainly on age. When successful, ION has a positive impact on surgical decision-making, ultimately providing an added element of safety for these patients.

Introduction: Intracranial epidermoid tumors are slow-growing lesions, which may recur after incomplete resection (surgery), but may do so over many years. These slow growing benign tumors encase and surround nerves and arteries rather than displacing them and the treatment of choice is radical surgery. Therefore the clinical symptoms are varies. The incidence of intracranial epidermoids is between 0.3% and 1.8% of all brain tumors. Whether the characteristics of tumor are related with culture of clinical neurologic in different developed and developing institution has not been discussed yet. Methods: Between 2015 until 2017, we collected data from two institutions, Keio University hospital Tokyo Japan and Hasan Sadikin Hospital Padjadjaran University Bandung Indonesia. We collect 16 patients from Keio University hospital (KUH) and 10 patients from Hasan Sadikin hospital (HSH). Results: In which the 11 cases is located in infratentorial and 5 cases were in supratentorial region at KUH. Meanwhile in HSH, we found that 10 patients were in infratentorial. The characteristic of cranial nerve palsy and/or neurological deficits are mainly similar in infratentorial region whether from KUH or HSH, including supratentorial epidermoid are also similar. At KUH, the location of epidermoid is located in the CPA (cerebellopontine angle) in 8 patients, 3 in suprasellar region, 1 in Meckel's cave, 1 in 4th ventricle, 1 in medulla, 1 in petroclival and 1 in occipital lobe. In HSH, the lesions are located in infratentorial in which 5 patient in CPA, 4 in petroclival region and 1 case in Meckel's cave. In infratentorial lesion the CNs (cranial nerves) palsy were found in CN IV, V, VI, VII, VIII, and none in IX, X, XI, XII. In supratentorial lesion the chief complaint was mainly headache. Conclusion: The epidermoid of the brain are mostly located in the infratentorial region rather than in supratentorial. The CNs deficit are commonly arose in infratentorial lesion meanwhile the supratentorial region symptom is headache. It is reasonable if the patient came with infratentorial multiple CNs palsy to be suspicious for epidermoid benign tumor in the intracranial. Those characteristics are found in both developed and developing hospitals. Keywords: Epidermoid, Infratentorial, Supratentorial, CNs palsy

BACKGROUND AND PURPOSE: Multiple sclerosis lesions develop around small veins that are radiologically described as the so-called central vein sign. With 7T MR imaging and magnetic susceptibility–based sequences, the central vein sign has been observed in 80%–100% of MS lesions in patients’ brains. However, a lower proportion ∼50% has been reported at 3T using susceptibility-weighted angiography (SWAN). Our aim was to assess a modified version of SWAN optimized at 3T for sensitive detection of the central vein sign. MATERIALS AND METHODS: Thirty subjects with MS were scanned on a 3T clinical MR imaging system. 3D T2-weighted FLAIR and optimized 3D SWAN called SWAN-venule, were acquired after injection of a gadolinium-based contrast agent. Patients showing >3 focal white matter lesions were included. The central vein sign was recorded by 2 trained raters on SWAN-venule images in the supratentorial brain. RESULTS: Twenty patients showing >3 white matter lesions were included. A total of 380 white matter lesions (135 periventricular, 144 deep white matter, and 101 juxtacortical) seen on both FLAIR and SWAN-venule images were analyzed. Overall, the central vein sign was detected in 86% of the white matter lesions (periventricular, 89%; deep white matter, 95%; and juxtacortical, 78%). CONCLUSIONS: The SWAN-venule technique is an optimized MR imaging sequence for highly sensitive detection of the central vein sign in MS brain lesions. This work will facilitate the validation and integration of the central vein sign to increase the diagnostic certainty of MS and further prevent misdiagnosis in clinical practice.

Purpose/objective(s) Tumor Treating Fields (TTFields) is an FDA-approved treatment for glioblastoma multiforme (GBM) and malignant pleural mesothelioma (MPM), and is currently being investigated in a phase III trial for the treatment of brain metastases from non-small cell lung cancer (NSCLC). Increased TTFields dose density at the tumor is associated with longer patient survival. Therefore, estimating dose at the tumor utilizing computational simulations with patient-specific computational models are integral for treatment planning. NSCLC brain metastases are often observed in infratentorial brain regions. In these cases, TTFields arrays may be placed on the head, neck, and upper back. Manual segmentation of this large area is impractical and time consuming. Therefore, we developed a computational method for semi-automatic segmentation of infratentorial tissues relevant to TTFields treatment planning. Materials/methods We incorporated a dataset of 20 head T1w Gad MRIs of patients treated with TTFields with segmentation of the infratentorial area, and 20 CT images that incorporate head, neck and upper torso from a public database for segmentation of extracranial structures. For the segmentation of the infratentorial zone we developed an atlas-based method that deforms a predefined statistical atlas to best fit the patient's MRI. Our method then revises the initial fitting to ensure the segmented structures adhere to known anatomical relations. For supratentorial brain areas, we incorporate a custom atlas-based method. Extra-cranial zones (head, neck and upper torso) were segmented with threshold-based methods for the skin, muscle, fat, bones, and bronchi. User-defined landmarks were used to segment the esophagus and the artery. The spine and CSF were segmented automatically by identifying the relevant area and defining a constant ratio between their diameters. To evaluate the segmentation of the infratentorial regions, a trained annotator manually segmented the infratentorial area of the 20 head MRIs. We compared manual and automatic segmentations and measured the Dice overlap score. Results The average Dice coefficient between the human annotator and the algorithms' segmentation was 0.84 (SD = 0.05) for cerebellum and 0.67 (SD = 0.05) for brainstem. These results are comparable to those observed in supratentorial regions with a method that was verified previously. The radiation oncologist confirmed that the semi-automatic segmentation of the infratentorial, and extracranial head, neck and upper torso provides a quality result for TTFields treatment planning in a reasonable amount of time for all cases. The infratentorial segmentation is fully automatic and typically lasts a few minutes. Segmentation of extracranial structures is semi-automatic and typically lasts less than an hour. Conclusion We have developed a fast method for the segmentation of infratentorial structures for TTFields planning.

Desmoplastic infantile ganglioglioma (DIG) is a rare supratentorial brain tumor occurring mostly before the age of 2 years. It has a good prognosis and total excision of the tumor is curative, necessitating no further treatment. An accurate pathologic diagnosis is crucial. Until now, approximately 70 cases of this tumor type have been reported. Solid-cystic variety is mostly described with occasional purely solid type lesion also. We are presenting a 12-month-old male infant with developmental delay and a giant cyst on the right side of supratentorial compartment, which showed histological features of desmoplastic ganglioglioma. Hence, the current case is reporting the rare histologic finding of cystic change in desmoplastic ganglioglioma. Cystic form of desmoplastic ganglioglioma should be considered in differential diagnosis of supratentorial cystic lesion in an infant. Prognosis is excellent after complete excision.

Primary central nervous system lymphomas are rare tumors of which B-cell is the most common type. Moreover; since these tumors do not have any pathognomonic sign radiologically, diagnosis is challenging. Optimal management of these tumors consist of chemotherapy, however, prognosis is poor and survival rate is low. These tumors are most commonly located in supratentorial region and infratentorial location is rare. Hereby we present a 58 years old female case with a cerebellar mass that was resected surgically and initiated on chemoradiotherapy along with steroids. In differential diagnosis of tumors located infratentorially, lymphomas should be taken into consideration despite its rarity and appropriate treatment should be planned accordingly.

Background: The goal of this retrospective study is to present the first epidemiological data on pediatric supratentorial central nervous system (CNS) tumors in Lebanon and to review the various surgical management strategies used. Methods: We conducted a retrospective case series of all pediatric patients who presented with a supratentorial CNS tumor and underwent surgery at our institution between 2006 and 2016. We collected and analyzed demographic characteristics, tumor location, clinical manifestations, histopathology, and surgical management strategies and outcome, and discussed them after dividing the tumors as per location and in view of published literature. Results: Ninety-nine children were studied with a male-to-female ratio of 2.3:1 and a mean age of 8.5 years. The most common location was convexity (44%) and included low-grade and high-grade glial tumors, along with other miscellaneous lesions. The next location was sellar/diencephalic (34%), including craniopharyngiomas, hypothalamic/optic pathway/thalamic gliomas, hamartomas, and pituitary/Rathke’s cyst, where there was notable use of endoscopic techniques (21%). Tumors in the pineal region (13%) were tectal gliomas, germ cell tumors, and pineoblastomas and were mostly treated endoscopically. The last group was lateral intraventricular tumors (8%) and was mostly choroid plexus lesions and ependymomas. Overall, the surgical objective was achieved in 95% with mild/moderate complications in 17%. Conclusion: A variety of pathologies may affect the pediatric population in the supratentorial region. Different surgical strategies, including microsurgical and endoscopic techniques, may be employed to remove, debulk, or biopsy these tumors depending on their location, suspected diagnosis, prognosis, and the need for treatment of possible associated hydrocephalus.

BACKGROUND A comparison of three different doses of mannitol on brain relaxation during supratentorial brain tumour craniotomy. Supratentorial tumours produce significant mass effects in the brain and certain types are accompanied by significant peritumoral oedema that leads to increased intracranial pressure. Higher osmotic pressure in the blood vessels after the infusion of mannitol drives water molecules from the brain tissue to blood vessels and results in brain tissue dehydration. The point of my study is to determine a dose that leads to a beneficial effect without triggering negative effects. MATERIALS AND METHODS This is a prospective, randomised single-blinded study conducted in Konaseema Institute of Medical Sciences, Amalapuram, from March 2015 to March 2017. After getting ethical committee approval and informed consent, 48 patients of both sexes (male and female) who underwent elective craniotomy for supratentorial tumour surgeries under general anaesthesia at were taken up for study. 48 patients were divided into three groups as group-A, group-B and group-C with 16 in each group. RESULTS There is significant change in brain relaxation score with increasing dose of mannitol. MAP and pH are significant with increasing dose of mannitol, serum sodium and potassium levels are also significant. Anion gap and urine output also showed significant change. Age, sex and BMI are not statistically significant. CONCLUSION From this study, it is concluded that 1.5 mg/kg of 20% mannitol gives better brain relaxation scores than 0.5 mg/kg of 20% mannitol and 1.0 mg/kg of 20% mannitol.

Gliosarcoma is a rare central nervous system (CNS) malignancy. It is characterized by classical biphasic histological pattern with both glial and sarcomatous components, often seen in fifth and sixth decade of life. They are generally located in the supratentorial region. Due to its rarity, exact treatment recommendations are not available in literature. Since it is considered as a variant of glioblastoma multiforme (GBM), it is treated with surgery followed by adjuvant radiotherapy and temozolomide-based chemotherapy. We present a series of four cases of this rare malignancy that were treated at our institute. World J Oncol. 2017;8(2):53-57 doi: https://doi.org/10.14740/wjon998w

BACKGROUND Brain tumours arise from the normal constituents of brain and its coverings; 80% of all the intracranial tumours are supratentorial. Imaging plays a crucial function in the management of patients with brain tumours. Magnetic Resonance Imaging (MRI) has earned recognition as the optimal screening technique for the detection of most intracranial tumours. MRI using conventional Spin-Echo sequences like axial T1, T2 and Fluid-Attenuated Inversion Recovery (FLAIR), coronal T2, sagittal T1, post contrast SE T1 axial, sagittal and coronal sequences were taken which provides inherently illustrious contrast resolution between structural abnormalities and adjacent brain parenchyma and has proved to be more sensitive in identification of focal lesions of the brain. MATERIALS AND METHODS The present study was conducted in 50 patients who all were clinically suspected of supratentorial brain tumour cases and underwent MRI in the Department of Radiodiagnosis, Konaseema Institute of Medical Sciences and Research Foundation, Amalapuram, during the period of 18 months from July 2015 to December 2016. RESULTS The MRI features of 50 supratentorial tumours were reviewed, out of which 72% were found to be extra-axial tumours and 28% intra-axial tumours. About 48% were found to be glial tumours and 52% were found to be non-glial tumours. CONCLUSION MRI proves to be a valuable modality of imaging in evaluating the characteristics, distribution, location and assessing the extent of various intra- and extra-axial tumours in the supratentorial region.

The fetal brain shows accelerated growth in the latter half of gestation, and these changes can be captured by 2D and 3D biometry measurements. The aim of this study was to quantify brain growth in normal fetuses using Magnetic Resonance Imaging (MRI) and to produce reference biometry data and a freely available centile calculator (https://www.developingbrain.co.uk/fetalcentiles/). A total of 127 MRI examinations (1.5 T) of fetuses with a normal brain appearance (21–38 gestational weeks) were included in this study. 2D and 3D biometric parameters were measured from slice-to-volume reconstructed images, including 3D measurements of supratentorial brain tissue, lateral ventricles, cortex, cerebellum and extra-cerebral CSF and 2D measurements of brain biparietal diameter and fronto-occipital length, skull biparietal diameter and occipitofrontal diameter, head circumference, transverse cerebellar diameter, extra-cerebral CSF, ventricular atrial diameter, and vermis height, width, and area. Centiles were constructed for each measurement. All participants were invited for developmental follow-up. All 2D and 3D measurements, except for atrial diameter, showed a significant positive correlation with gestational age. There was a sex effect on left and total lateral ventricular volumes and the degree of ventricular asymmetry. The 5th, 50th, and 95th centiles and a centile calculator were produced. Developmental follow-up was available for 73.1% of cases [mean chronological age 27.4 (±10.2) months]. We present normative reference charts for fetal brain MRI biometry at 21–38 gestational weeks. Developing growth trajectories will aid in the better understanding of normal fetal brain growth and subsequently of deviations from typical development in high-risk pregnancies or following premature delivery. Electronic supplementary material The online version of this article (doi:10.1007/s00429-016-1342-6) contains supplementary material, which is available to authorized users.

Multinodular and vacuolating neuronal tumor of the cerebrum is a rare supratentorial brain tumor described for the first time in 2013. Here, we report 11 cases of infratentorial lesions showing similar striking imaging features consisting of a cluster of low T1-weighted imaging and high T2-FLAIR signal intensity nodules, which we referred to as multinodular and vacuolating posterior fossa lesions of unknown significance. No relationship was found between the location of the lesion and clinical symptoms. A T2-FLAIR hypointense central dot sign was present in images of 9/11 (82%) patients. Cortical involvement was present in 2/11 (18%) of patients. Only 1 nodule of 1 multinodular and vacuolating posterior fossa lesion of unknown significance showed enhancement on postcontrast T1WI. DWI, SWI, MRS, and PWI showed no malignant pattern. Lesions did not change in size or signal during a median follow-up of 3 years, suggesting that multinodular and vacuolating posterior fossa lesions of unknown significance are benign malformative lesions that do not require surgical intervention or removal.

BACKGROUND: Goal-directed fluid therapy (GDFT) improved patient outcomes in various surgical procedures; however, its role during mass brain resection was not well investigated. AIM: In this study, we evaluated a simple protocol based on intermittent evaluation of pulse pressure variation for guiding fluid therapy during brain tumour resection. METHODS: Sixty-one adult patients scheduled for supratentorial brain mass excision were randomized into either GDFT group (received intraoperative fluids guided by pulse pressure variation) and control group (received standard care). Both groups were compared according to the following: brain relaxation scale (BRS), mean arterial pressure, heart rate, urine output, intraoperative fluid intake, postoperative serum lactate, and length of hospital stay. RESULTS: Demographic data, cardiovascular data (mean arterial pressure and heart rate), and BRS were comparable between both groups. GDFT group received more intraoperative fluids {3155 (452) mL vs 2790 (443) mL, P = 0.002}, had higher urine output {2019 (449) mL vs 1410 (382) mL, P < 0.001}, and had lower serum lactate {0.9 (1) mmol versus 2.5 (1.1) mmol, P = 0.03} compared to control group. CONCLUSION: In conclusion, PPV-guided fluid therapy during supratentorial mass excision, increased intraoperative fluids, and improved peripheral perfusion without increasing brain swelling.

Patient: Female, 28 Final Diagnosis: Gliosarcoma Symptoms: Foot drop Medication: — Clinical Procedure: — Specialty: Neurosurgery Objective: Unusual clinical course Background: Gliosarcoma (GS) is a rare variant of glioblastoma (GBM), which is typically seen in patients age 40–60 years and located in the supratentorial region. We present an unusual case of GS in a young patient with an unusual presentation, which eventually led to the finding of this neoplasm. Case Report: Our patient was a 38-year-old woman originally from the Philippines who was transferred to our institution with an isolated left foot drop that developed over the course of several months. Subsequent neuroimaging revealed an extensive mixed cystic and solid mass in the posterior mesial right frontal lobe. Subtotal surgical resection revealed a multi-lobed tumor with a malignant glioma-like surface component overlying a smooth, well-encapsulated, avascular, sarcoma-like component. Neuropathologic examination of the resected tumor revealed a biphasic histologic pattern of predominantly sarcomatous components with fewer adjacent-area glial components. Post-operatively, the patient was left with a mild worsening of left leg segmental strength. She was referred to our neurooncologist colleagues for adjuvant treatment options. Conclusions: Our case is unique in that it represents a rare neoplasm in a patient whose demographics are atypical for this type of tumor, as well as the unusual presentation of isolated foot drop.