• Discussion:

    Case Explanation:
    This patient presents with a dominant hemisphere high grade glioma

    Answer feedback for Question 1
    The best answer is high grade glioma. The lesion is contrast enhancing (fig 1A,C,D), does not restrict diffusion (fig 1E), and has increased cerebral blood flow around the infiltrative margin (fig 1F red arrows).

    Answer feedback for Question 2
    The best answer is smaller tumor volume. Numerous studies have demonstrated increased rates of GTR with smaller tumor volume, perilesional resection, and presumed non eloquent location.

    Answer feedback for Question 3
    The best answer is the combined use of temozolomide plus radiation. Based on WHO 2016, glioblastoma are classified both molecularly as well as histologically. The presence of an IDH 1 or 2 mutation offers a survival benefit in addition to gross total resection of contrast enhancing disease and younger age (<65).

     

    References:

    1. Al-Holou WN, Hodges TR, Everson RG, Freeman J, Zhou S, et al. Perilesional resection of glioblastoma is independently associated with improved outcomes. Neurosurgery. 2019 Feb;2(0):1-10.
    2. Stupp R, Mason WP, van den Bent MJ et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med. 2005;352 (10):987-996.
    3. Brown TJ, Brennan MC, Li M et al. Association of extent of resection with survival in glioblastoma. JAMA Oncol. 2016;2(11):1460-1469.

     

    Recommended products:

    Nexus:
    https://cnsnexus.crowdwisdomhq.net/nexus/article/13217
    https://cnsnexus.crowdwisdomhq.net/nexus/article/13984
    https://cnsnexus.crowdwisdomhq.net/nexus/article/13366

    SANS:
    https://www.cns.org/course-detail/sans-tumor-module

    Guidelines:
    https://www.cns.org/guidelines/browse-guidelines-detail/1-introduction

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