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Ganglioglioma

 

Clinical history
11-year-old girl presented with a six-week-history of repeated vomiting, headache, and unsteadiness of gait.
Clinical examination revealed a left cerebellar syndrome, a left hemiparesis, nystagmus on upward gaze, loss of sensation in the left hand, and daily hiccups.
A CT-scan was performed and showed enlarged ventricles with slight deformation of the fourth ventricle.
McCormick grade II disability was noted, without urinary disturbances.

Pre-operative MRI (July 1988)
Image 1: Sagittal T1WI. Tumor infiltration of the medulla oblongata and upper cervical cord is seen without clear margins, as the tumor is iso-intense to normal brain and spinal cord.
Image 2: Sagittal Gd T1WI. Intense, heterogeneous, and ill-defined tumor enhancement.

Surgery
At surgery, an infiltrating tumor was found, but no cleavage plane could be identified and only a biopsy could be performed. After biopsy, radiotherapy was delivered.

Histology
Ganglioglioma grade II.

Follow-up MRI (July 1989)
Images 3 - 4: Sagittal T1WI. The tumor infiltration is more obvious and more extensive. Note the post-operative cervical kyphosis and the hyperintense bone marrow, the latter due to radiation therapy.
Images 5 - 7: Sagittal Gd T1WI. The inhomogeneous contrast enhancement is more extensive than one year before.
Images 8 - 10: Coronal T1WI. The tumor infiltration is more obvious and more extensive. Note the post-operative cervical kyphosis and the hyperintense bone marrow, the latter due to radiation therapy.
Images 11 - 13: Coronal Gd T1WI. The inhomogeneous contrast enhancement is more extensive than one year before.

Second follow-up MRI (February 1990)
Images 14 - 16: Sagittal T1WI.
Images 17 - 19: Sagittal Gd T1WI.
Image 20: Coronal Gd T1WI.
Images 21 - 22: Axial Gd T1WI.
The size and the signal characteristics of the tumor are virtually unchanged.

Third follow-up MRI (January 1992)
Images 23 - 25: Sagittal T1WI.
Images 26 - 27: Sagittal PD image.
Images 28 - 30: Sagittal Gd T1WI.
Images 31 - 34: Coronal Gd T1WI.
The tumor has enlarged moderately.

Post-operative clinical course
The patient's neurological status remained stable over five years.

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Fig. 1

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