0:00

Here's another patient with a left

0:03

anterior insular lesion.

0:04

It's in the, um, an left anterior middle short insular gyri.

0:11

Um, can see here on this coronal image, it, it's starting

0:15

to skew around, um, the depth of that sulcus right there

0:19

to the left inferior frontal, um, gyrus.

0:24

The functional MRI overlay here shows

0:29

ex uh, expressive language is immediately next to

0:33

that little, uh, corner right there.

0:36

So obviously this is very challenging

0:38

and this is the actual, like surgical planning.

0:42

Uh, you know, that was done instead

0:45

of blue going straight in.

0:47

The thought would be to, to go over and up.

0:50

So as opposed to going straight into this, to go over

0:52

and up to spare some of the functional, um, uh,

0:55

characteristics of the overlying, um,

1:00

parts of peris of the left inferior frontal gyrus

1:03

where expressive language was, uh,

1:06

and a gross total resection was, was achieved.

1:10

Um, this was a diffuse astrocytoma, again,

1:14

previously referred to as a fibrillary astrocytoma,

1:16

a gross total resection.

1:17

There was no language deficit.

1:19

Now the reason I, I mentioned this in comparison

1:22

to the co prior one is a diffuse

1:26

astrocytoma can actually appear to have discrete margins.

1:29

So that's one of the things that can be confusing.

1:32

So just because something has discre appears

1:35

to have discreet margins on imaging, um,

1:39

it still can be a diffuse astrocytoma.

Case: Diffuse Astrocytoma With Apparent Discrete Margins

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0:00

Here's another patient with a left

0:03

anterior insular lesion.

0:04

It's in the, um, an left anterior middle short insular gyri.

0:11

Um, can see here on this coronal image, it, it's starting

0:15

to skew around, um, the depth of that sulcus right there

0:19

to the left inferior frontal, um, gyrus.

0:24

The functional MRI overlay here shows

0:29

ex uh, expressive language is immediately next to

0:33

that little, uh, corner right there.

0:36

So obviously this is very challenging

0:38

and this is the actual, like surgical planning.

0:42

Uh, you know, that was done instead

0:45

of blue going straight in.

0:47

The thought would be to, to go over and up.

0:50

So as opposed to going straight into this, to go over

0:52

and up to spare some of the functional, um, uh,

0:55

characteristics of the overlying, um,

1:00

parts of peris of the left inferior frontal gyrus

1:03

where expressive language was, uh,

1:06

and a gross total resection was, was achieved.

1:10

Um, this was a diffuse astrocytoma, again,

1:14

previously referred to as a fibrillary astrocytoma,

1:16

a gross total resection.

1:17

There was no language deficit.

1:19

Now the reason I, I mentioned this in comparison

1:22

to the co prior one is a diffuse

1:26

astrocytoma can actually appear to have discrete margins.

1:29

So that's one of the things that can be confusing.

1:32

So just because something has discre appears

1:35

to have discreet margins on imaging, um,

1:39

it still can be a diffuse astrocytoma.

Report

Faculty

Asim F Choudhri, MD

Chief, Pediatric Neuroradiology

Le Bonheur Children's Hospital

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Case: Diffuse Astrocytoma With Apparent Discrete Margins