Cingulate gyrus glioma
J.Sales-Llopis, J.Abarca-Olivas, P.González-López
Neurosurgery Department, University General Hospital of Alicante, Spain
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Case report from the HGUA
A 42-year-old male was admitted for episodes of dizziness and sweating followed by loss of consciousness of at least 15 minutes, Predominantly left retro-ocular headache, intermittent, of months of evolution with worsening in the last 3 days and 2 vomits of food content two days ago. He refers subconjunctival hemorrhage of a long evolution.
The CT showed an extensive hypodense space-occupying lesion in the midline centered in the corpus callosum/cingulate gyrus with a cystic appearance (11 HU of mean attenuation) without clear enhancement or calcifications, measuring approximately 12 cm x 6.8 cm x 9 cm (ap x tra x DC). The lesion is predominantly left and seems to follow the orientation of the cingulate gyrus, positioning itself anterior to the knee of the corpus callosum and superior to the trunk of the corpus callosum, imprinting on it and thinning its posterior third, displacing the splenium of the corpus callosum posterosuperior.
In the MRI the infiltrative neoplastic lesion is centered on the left cingulate gyrus of at least 13 cm x 6 cm x 9.2 cm (ap x tra x cc) that distorts and infiltrates the body and part of the splenium of the corpus callosum, crossing the midline and producing a subfalcine herniation to the right with a deviation of about 9 mm from the midline and compression of the left ventricular atrium.
Left lateral decubitus position, leaving the right cerebral hemisphere in a declining position. Coronal skin incision. Paramedian craniotomy at the left precoronal level. Pedicled dural opening to sagittal sinus. Interhemispheric dissection until reaching the cingulate region where tumor insufflation can be seen. Excision of the anterior half of the cingulate gyrus is performed at the level of the body of the corpus callosum. Resection is limited to that height due to anatomical limitations and the intention to preserve the corpus callosum. Correct vascularization with indocyanine is verified. hemostasis. Hermetic dural closure. Skull replacement with 3 trephine plates. Subcutaneous plane closure with absorbable suture and skin staple.
Low-grade glioma intraoperative PA