• - A 35-year old female with intermittent headaches undergoes MR-imaging evaluation and is identified with a dural-based lesion. 

    - Past medical and surgical history are not contributory. 

    - Physical exam is normal.

    Figure 1. MR-imaging reveals a dural-based enhancing mass occupying the parasagittal angle just anterior to the level of the coronal suture. A small amount of local mass effect is noted, but there is no edema in the adjacent left frontal lobe.

    1. A MR-venogram is obtained and reveals that the superior sagittal sinus remains patent. What would your recommendation to this patient be?

    2. The most consistent cytogenetic alteration found in WHO grade I sporadic meningiomas is:

    3. The 5-year progression free survival associated with use of radiosurgery as the initial management strategy for small to medium-size meningiomas

    4. Which of the following describes you?

    5. I practice in one of the following locations.

    6. Please add any suggestions or comments regarding this case:

    • Please for all casse we need to have a final teaching review made by an expert in the field. These cases on monthly basis are very useful but we miss the conclusion.
    • IN MY PRACTICE I WOULD LIKE TO REMOVE THE TUMOUR WHICH I AM DOING FOR LAST 33 YRS. THE PROCEDURE IS BENIGN IN MY HAND. I USE USA FOR DEBULKING FOLLOWED BY TUMOUR CAPSULE REMOVAL. BUT AS PRESENTLY RADIOSURGERY UNIT IS AVAILABLE AT DOO STEP I RATHER ADVISE FOR RS.
    • please have an expert discuss the case for everyone's educational benefit
    • We think that at this location surgery is more cost benefit
    • I will make a surgery only if the patient begin with neurologic sintoms.
    • Melanoma is a cancer that statrs in a certain type of skin cell.Here is what a melanoma appears like:asymmetry – the condition of a single half does not match up the other.Border – the edges are typically ragged, notched, blurred, or irregular in outline; the pigment may perhaps distribute to the surrounding skin.Color – the coloring is uneven. Shades of black, brown, and tan may perhaps be present. locations of white, grey, red, pink, or blue also may perhaps be seen.Diameter—there may be a alter in size, generally an increase. Melanomas are generally bigger compared to eraser of the pencil (1/4 inch or five millimeters).Watch for modifications in the molemelanomas in an earlier point may perhaps be discovered when an current mole modifications slightly, for example, when a brand name new dark region forms. Newly shaped good scales and itching in the mole also are typical signs and symptoms of earlier melanoma. In much more innovative melanoma, the texture within the mole may perhaps change. For example, it may perhaps turn into tough or lumpy. Melanomas may perhaps really feel unique from standard moles. much more innovative tumors may perhaps itch, ooze, or bleed. But melanomas generally do not bring about pain.Hope this has helped!
    • What is the correct answer for Question 2?
    • Meningioma grade is the greatest risk factor for progression. Progression free survival is high with meningiomas because the vast majority of them are grade 1. Size influences the likelihood the tumor will be symptomatic. As in this case, small meningiomas are generally asymptomatic. Serial imaging provides a low risk option to determine the likelihood that an asymptomatic dural based mass will progress.
    • good case
    • i could answer what i knew i am not updated sorry Dr.K.vijayaraghavan
    • In my set up and country RS not yet available. And in my hand surgery is benign without any postoperative functional morbidity.I am practicing for last 22 yrs as neurosurgeon-academic and practicing.

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