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Astrocytoma, case 4

 

Clinical history
The clinical signs in this 58-year-old patient began as much as 18 years earlier. At that time the patient complained of progressive weakness of the right hand and leg, but as all investigations were negative, a diagnosis of "degenerative" disease was made.
The patient's clinical condition progressively worsened and at the time when re-evaluation was pursued, the patient was unable to walk normally (McCormick grade III) and urinary disturbances were present.
At clinical examination, a right Brown-Sequard syndrome was observed at the level of C5. A right motor deficit was noted and the CSF exhibited an elevated protein.

Pre-operative MRI
Images 1 - 2: Sagittal T1WI. Spinal cord enlargement from C3 to T2: ill-defined iso/slightly hyperintense mass lesion.
Images 3 - 4: Sagittal Gd T1WI. Intense but inhomogeneous tumor enhancement

Surgery
Video 1: astrocytoma 
Complete resection of this extensive tumor was possible through a C4-T4 laminectomy. A distinct cleavage plane was found, and no cysts or hemorrhage were seen.

Stage 1: Well-defined margins between the tumor and the spinal cord.
Stage 2: Separation of the tumor from the spinal cord.
Stage 3: Low magnification view of the tumor.
Stage 4: Dissection of the tumor.
Stage 5: Debulking with CUSA (Cavitron Ultrasonic Surgical Aspirator).
Stage 6: Dissection of the tumor from the anterior portion of the spinal cord.
Stage 7: Separation of the tumor.
Stage 8: Removal of the tumor.
Stage 9: Low magnification view of the operative field.

Histology
Astrocytoma Grade II.

Post-operative clinical course
The neurological deficit was unchanged immediately after surgery. Three months later, gait improved and the patient could ambulate independently (McCormick II). However, hypoesthesia of the right leg persisted. The patient's condition remained stable after three years follow-up.

Post-operative MRI
Images 5 - 6: Sagittal T1WI. Shows post-operative spinal cord atrophy.
Images 7 - 8: Sagittal PD image and sagittal T2WI. Spinal cord atrophy is well seen. No abnormal signal intensity is identified in the cord.
Images 9 - 11: Sagittal Gd T1WI. Absence of abnormal contrast uptake.
Image 12: Series of axial Gd T1WI. Spinal cord atrophy with no residual tumor.

See also:
- Astrocytoma

 

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Fig. 1

Astrocytoma, case 4, Fig. 1
Astrocytoma, case 4, Fig. 2
Astrocytoma, case 4, Fig. 3
Astrocytoma, case 4, Fig. 4
Astrocytoma, case 4, Fig. 5
Astrocytoma, case 4, Fig. 6
Astrocytoma, case 4, Fig. 7
Astrocytoma, case 4, Fig. 8
Astrocytoma, case 4, Fig. 9
Astrocytoma, case 4, Fig. 10
Astrocytoma, case 4, Fig. 11
Astrocytoma, case 4, Fig. 12