Case 2: Operative Record

This case is a right-handed 40-year-old woman. A right parietal tumor was detected incidentally. The tumor is located posterior to the sensory area. Low-grade glioma was suspected according to the preoperative radiological examinations.
The operation was performed under a general anesthesia. The patient was laid in a left lateral position. Her head was rotated slightly to the left and fixed with vertex-up position. A U-shaped skin incision was made as shown in Figure 1. We performed two burr holes and made a 3x4 cm bone flap. The dural incision is also shown in Figure 1. The brain surface was slightly pale and voluminous.
At first, we confirm the location of the tumor by the neuro-navigation system. Then we removed the tumor, though the tumor margin was not clear. The rapid diagnosis was a diffuse astrocytoma as expected. The ventricular system was not opened.
We confirmed no blood oozing from the resected cavity wall. Then we sutured the dura mater water-tightly and fixed the bone flap with fixators. The skin was sutured in due form. 
On the MR images immediately after the operation, about 95% of the tumor was resected. Only a small amount of the residual tumor was recognized at the anterior side of the removal wall.

Case 2: Case Presentation

This case is a 40-year-old woman who was referred to our hospital three months ago.

She is right-handed, has no allergy, and has no medical history. Her parents and two sons are all healthy. She was involved in a traffic accident and hit her head four months ago. She visited a local hospital and was examined with an MR study. An abnormal signal was detected in her right parietal lobe. Neurological findings were completely normal when she first visited our hospital. On the follow-up MR images, which were taken three months later, the abnormal signal had not changed.

These are the MR images. We can see a lesion in her right parietal lobe. The lesion is located between the brain's surface and deep white matter. The margin is unclear, and the surrounding normal structures were a little compressed by the lesion. Based on these findings, low-grade glioma is most likely. We should consider encephalitis as a differential diagnosis.

I told her the possibility that the lesion could be a low-grade glioma, so she wanted to receive an operation to make a histological diagnosis. She was admitted to our ward today, and the surgical operation is planned for the day after tomorrow.