Mark Hornyak, MD

This a case from a 52 year old woman presenting to ER with new onset seizure.

• All
• Pre-Op
• Intra-op
• Post-op

CT scan of the head showing an abnormality in the left frontal region (top right of image). It includes a bright white area consistent with calcification. The adjacent brain is darker on that side due to edema, and the midline structures of the brain are pushed over top the right (called midline shift).

Axial images from MRI of the brain. On the left is the post-contrast T1 image showing the tumor (bright white) and the adjacent brain (grey). On the right is a FLAIR image which shows edema within the brain as white. They both show the tumor and midline shift.

Additional T1-postcontrast MR images. On the left is a coronal section through the tumor, and on the right is a sagittal section.

Photograph taken in the operating room. A narrow channel of hair has been clipped from the left side of the head and the planned incision has been marked with a surgical skin marker.

Intraoperative photo taken through the operating microscope. It shows the interface (arrows) between the tumor (top left) and the brain (bottom right). Note the adherence of the tumor to the cortical surface.

CT head acquired immediately postop. It shows air in the surgical bed (dark black) and other routine postop changes.

A photomicrograph of a pathological slide showing the microscopic architecture of the tumor. This and other slides allow the final pathological diagnosis to be made. In this case – benign meningioma (WHO grade 1).

Post-operative MRI acquired 3 months after operation. Compare with figure 2: it shows that the tumor has been removed and there has been resolution of cerebral edema in the brain adjacent to the tumor.

Post-operative MRI acquired 3 months after operation. Compare with figure 3: it also shows that the tumor has been removed.