1. NTUH Neurosurgery Morning Meeting Case Discussion Date: 2015/04/21 Presented by PGY 何御彰

2. Basic profile Age: 40 y/o Sex: Female Diagnosis – Right temporal-parietal tumor, suspected high grade glioma Past history – Uterine myoma, status post myomectomy (2006/04/13)

3. History Chief complaint – Focal seizure affecting left upper limb with subsequent weakness on 2015/03/30 Present illness – 2015/03/30Weakness in left upper limb without LOC  Cheng-Ching Hospital, Head CT  Right temporal-parietal brain tumor – 2015/04/07Admission

4. Imaging study Head CT (2015/03/30)

5. Imaging study Brain MRI (2015/04/08)

6. Imaging study Brain MRI (2015/04/08)

7. Imaging study

9. NE Consciousness – Clear and alert, E4M6V5 Gait – Stable Cranial nerve – Normal

10. NE 5/5 ++ ↓↓ 5/5

11. Operation (2015/04/09) Pre-operative diagnosis – Right temporal-parietal tumor, suspected high grade glioma Operative method – Right fronto-temporal craniotomy

13. Operation (2015/04/09) Operative finding – A 5.0 x 5.5 x 4.0 cm, whitish-to-grayish, hypovascularized, soft, fragile and ill-demarcated tumor mainly located over the right posterior frontal lobe (about pre-motor cortex region by intra-operative mapping) – Intra-operative left hand and foot MEP decreased and even vanished several times. The left foot MEP recovered to the baseline and the left hand MEP decreased in the end of the operation Frozen – A glioma of at least WHO grade II is considered

14. Post-operative course Final pathology – Glioblastoma with oligodendroglioma component (WHO grade IV) – p53 (+), IDH-1 (+) Consciousness – Clear and alert, E4M6V5 Muscle power – Full Cranial nerve – Normal