Radiological Dilemma in an Extra-axial Petroclival Lesion: Low vs High Grade.

Radiological Dilemma in an Extra-axial Petroclival Lesion: Low vs High Grade.

World Neurosurg. 2017 Jan 18;:

Authors: Karthigeyan M, Ahuja CK, Chatterjee D, Salunke P

Abstract
BACKGROUND: Radiological differentiation between a low and high grade lesion is crucial on deciding the extent of resection and prognostication. Occasionally the imaging features can be confusing between the two. We report such a case which was a radiological dilemma. The lesion appeared apparently benign and extra-axial on routine magnetic resonance (MR) sequences. However, there were subtle clinical and imaging clues towards high grade lesion.
CASE DESCRIPTION: A 27-year-old lady presented with multiple cranial nerve palsies, gait ataxia and features of raised intracranial pressure. Computed tomography and MR imaging showed a petroclival extra-axial contrast-enhancing lesion with areas of chunky calcification. Although choline peak on spectroscopy raised the suspicion of high grade lesion, the primary differential was meningioma/ schwannoma considering its characteristic imaging appearance. The post-operative histopathology however turned out to be giant-cell glioblastoma.
CONCLUSION: Apart from reporting a rare variant of glioblastoma in an unusual location, the case highlights atypical imaging in a glioblastoma. The brainstem edema may be a subtle indicator of infiltrative nature of tumor. MR spectroscopy may be a useful adjunct in such circumstances.

PMID: 28109858 [PubMed - as supplied by publisher]

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