0:00

Here's a patient with a, um, left thal pular tumor in the,

0:05

um, uh, left, uh, thalamus, uh, cerebral peduncle

0:10

and left aspect of the mesencephalon.

0:13

So it was a discreet lesion d um,

0:17

very different than the infiltrated bi thalamic, um,

0:20

duse mid glioma that we saw, uh, a moment ago.

0:24

Some heterogeneous post contrast enhancement

0:27

facilitated diffusion and posteriorly.

0:30

We see it actually extends to the peel surface right there,

0:34

and we thought this is a possible opportunity of access.

0:37

Um, we, we looked at this interlateral margin.

0:42

These, the blue fibers here is the descending fibers,

0:44

the corticospinal tract.

0:47

And we're seeing, um, that there

0:51

comes down, comes down to the cerebral Pete Oncle.

0:54

Now here it gets sort of this purplish or magenta.

0:57

And so, and then we see the fibers down here in

1:00

the pons below the lesion.

1:02

So, um, we proceeded to do a resection through that.

1:07

Um, vocally exophytic access point on,

1:11

on the right, uh, left, um, dorsal lateral aspect

1:15

of the mesencephalon.

1:17

And so a, a gross total resection was achieved.

1:21

Uh, the, the corticospinal tract remained intact.

1:25

Um, so here's pre-op and post-op.

1:27

There's some ed edema here

1:29

that resolved on subsequent imaging.

1:31

So again, just

1:33

because you have a lesion in the gland, in the thalamus, it,

1:36

it doesn't mean that it's a diffuse mid lung glioma.

1:39

This was actually a pilocytic astrocytoma histologically.

Case: Pilocytic Astrocytoma Arising From the Thalamus

HIDE

Prev Next

Interactive Transcript

Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

Here's a patient with a, um, left thal pular tumor in the,

0:05

um, uh, left, uh, thalamus, uh, cerebral peduncle

0:10

and left aspect of the mesencephalon.

0:13

So it was a discreet lesion d um,

0:17

very different than the infiltrated bi thalamic, um,

0:20

duse mid glioma that we saw, uh, a moment ago.

0:24

Some heterogeneous post contrast enhancement

0:27

facilitated diffusion and posteriorly.

0:30

We see it actually extends to the peel surface right there,

0:34

and we thought this is a possible opportunity of access.

0:37

Um, we, we looked at this interlateral margin.

0:42

These, the blue fibers here is the descending fibers,

0:44

the corticospinal tract.

0:47

And we're seeing, um, that there

0:51

comes down, comes down to the cerebral Pete Oncle.

0:54

Now here it gets sort of this purplish or magenta.

0:57

And so, and then we see the fibers down here in

1:00

the pons below the lesion.

1:02

So, um, we proceeded to do a resection through that.

1:07

Um, vocally exophytic access point on,

1:11

on the right, uh, left, um, dorsal lateral aspect

1:15

of the mesencephalon.

1:17

And so a, a gross total resection was achieved.

1:21

Uh, the, the corticospinal tract remained intact.

1:25

Um, so here's pre-op and post-op.

1:27

There's some ed edema here

1:29

that resolved on subsequent imaging.

1:31

So again, just

1:33

because you have a lesion in the gland, in the thalamus, it,

1:36

it doesn't mean that it's a diffuse mid lung glioma.

1:39

This was actually a pilocytic astrocytoma histologically.

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: Pilocytic Astrocytoma Arising From the Thalamus