Brain Tumor Res Treat.  2024 Jan;12(1):75-79. 10.14791/btrt.2023.0044.

Awake Surgery for Angiocentric Glioma in the Eloquent Area in an Adolescent: A Case Report

• Yano Y
• Matsuda R
• Okada F
• Takeda M
• Maeoka R
• Nakgawa I

• KMID: 2552344
• DOI: http://doi.org/10.14791/btrt.2023.0044

Abstract

Angiocentric glioma (AG) is an extremely rare tumor that often develops in adolescents. Awake surgery for AG occurring in the eloquent area has not been reported to date. We report a case involving a righthanded 15-year-old boy with AG. He presented with a first-time generalized tonic-clonic seizure and was rushed to the local hospital. CT of the head indicated a left frontal low-density mass with no calcification. He was subsequently referred to our hospital. Comparison with a CT scan obtained two years prior due to mild head trauma indicated that the lesion showed a trend toward enlargement. The lesion was located in the anterior and lateral portions of the primary motor cortex, and MRI showed homogenous hypointensity on T1-weighted and hyperintensity on T2-weighted images. Contrast-enhanced MRI showed a linear contrast effect. The patient underwent awake surgery with successful intraoperative brain mapping and total resection, and brain function was preserved. Pathological analysis revealed AG. He returned to his normal life and has shown no recurrence without additional treatment for 2 years. Thus, awake surgery for complete tumor resection while preserving brain function is effective and safe even in adolescents with AGs.

Keyword

Glioma; Surgery; Adolescent; Brain mapping

Figure

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  Fig. 1 Preoperative MRI images. MRI of the brain showing a left frontal lesion on T2-weighted axial and coronal images (A and B), and fluid-attenuated inversion recovery images (C). Enhanced MRI showing a linear contrast effect in the posterior part of the lesion (D: yellow arrow).

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  Fig. 2 Intraoperative images. A: Intraoperative photograph of the surface of the exposed operative field. The tumor boundaries identified using ultrasonography and neuro-navigation are marked by alphabets (A–E). The eloquent cortical sites identified using electrical stimulations are marked by numbers as follows: 1: primary motor cortex of the face, and 2: phonemic paraphasia. B: Intraoperative photograph after resection. The eloquent sites of the white matter identified using electrical stimulations are marked by numbers as follows: 47–49: facial dysfunction (pyramidal tract).

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  Fig. 3 Postoperative MRI images. T2-weighted axial (A) and coronal (B) images obtained the day after surgery showed gross total removal.

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  Fig. 4 Histopathological images. Histopathological examination showed that tumor cells were oriented around the capillaries (A and B: hematoxylin-eosin staining, ×200). These cells were positive for glial fibrillary acidic protein (×200) (C), while the Ki-67 immunolabelling index (×200) value was 2.4% (D).

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