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BACKGROUND Supratentorial tumours mostly present with non-specific complaints such as headache, stroke like syndrome or seizures. Often a diagnosis is made or suggested initially by findings on imaging studies. We wanted to study the imaging findings of supratentorial tumours, so as to deliver the best possible diagnosis and treatment for the patient. METHODS All clinically suspected supratentorial brain tumour cases undergoing Magnetic Resonance Imaging (MRI) at GSL Medical College and General Hospital, Rajahmundry, were included in this study. All scans were performed with 1.5 Tesla MRI. Pre-contrast scanning was done using axial T1, T2 and FLAIR; coronal T2 and sagittal T1 with a slice thickness of 5 mm. Post-contrast coronal, sagittal and axial T1WI were obtained. If required, thinner sections were obtained in the region of interest wherever necessary. Special MRI sequences like FLAIR (Fluid Attenuated Inversion Recovery Sequence), and DWI (Diffusion Weighted Imaging) were obtained. RESULTS In this study, 53 cases were diagnosed with supratentorial tumours. Glioma was the most common diagnosis (49%). Peak incidence of neoplasms was seen in fifth decade and the lowest incidence was seen in the first decade. 29 patients were males and 24 patients were females. Headache was the commonest presenting complaint. Twenty-three tumours were homogenous, 22 were heterogenous and 7 had non-enhancing pattern. CONCLUSIONS Multiplanar capability of MRI is helpful in identifying the precise anatomic location and the exact extent of the tumours. Post contrast images clearly define the size, margins, and nature of the tumour and also improves the differentiation between the tumour and surrounding edema.

ResumenAntecedentesEl astrocitoma pilocítico es un tumor poco frecuente, con predilección por los pacientes pediátricos, localizado principalmente en la fosa posterior. Suele presentarse con síntomas de hidrocefalia y aumento de la presión intracraneana y menos frecuentemente con epilepsia o déficit neurológico focal. El estudio de elección es la resonancia magnética, en la cual se observa una lesión con componentes sólidos y quísticos, sin edema perilesional. El tratamiento de elección es la resección total y si se logra, se puede considerar curado al paciente.Caso clínicoSe presenta el caso de una paciente femenina de 22 años de edad con un astrocitoma pilocítico supratentorial, quien comenzó con epilepsia. Patología: Se reportó proliferación glial de bajo grado, con matriz fibrilar extensa y células pequeñas sin atipia, con extensas calcificaciones, con áreas piloides conformadas por células fusiformes bipolares, con algunas fibras de Rosenthal. También se observaron áreas espongióticas conformadas por células multipolares asociadas a microquistes. El resultado fue un astrocitoma pilocítico.ConclusionesEl astrocitoma pilocítico es más frecuente en pacientes pediátricos y en la fosa posterior. El caso presentado es de una adulta joven y con una localización supratentorial, lo cual lo hace un caso especial. La cirugía logró una resección completa. El pronóstico es muy bueno a largo plazo, aunque es necesario hacer un seguimiento especialmente en los pacientes adultos, ya que se han reportado casos con recurrencia.AbstractBackgroundPilocytic astrocytoma is a rare tumour, usually occurring in paediatric ages, and mainly located in the posterior fossa. It can cause hydrocephalus and intracranial hypertension and, less frequently, seizures, or a focal neurological deficit. The main imaging study by magnetic resonance imaging, which shows a tumour with solid and cystic components without peri-lesional swelling. The election treatment is surgical, and the patient is considered cured if a total resection is accomplished.Clinical caseThe case is presented of 22-year-old female patient with a supratentorial pilocytic astrocytoma and epilepsy. Histopathology reported a low grade glial proliferation, with an extensive fibrillar matrix, small cells without atypia, extensive calcifications and piloid areas consisting of bipolar fusiform cells, and some Rosenthal fibres. There were also spongiotic areas consisting of multipolar cells and associated microcysts. The final report was a pilocytic astrocytoma.ConclusionsPilocytic astrocytoma is more frequent in paediatric patients and in the posterior fossa. The case presented is of a young female adult with supratentorial location, making it a special case. The surgery achieved a total resection. The long-term prognosis is good, but it is necessary to perform a follow-up, particularly in adult patients because of a higher risk of recurrence.

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.

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.