[Multiple cerebral glioma or tumor dissemination via CSF pathways? Case report]

A case is presented of a 38-year-old female patient who developed bifocal metachronous cerebral glioma with the same histological appearance (glioblastoma multiforme). Two separate tumors were operated on within six months: the first one was localized in the left parieto-occipital area, and the other in the right temporal lobe. The tumor cells dissemination occurred probably via the CSF pathways: during the first operation the posterior horn of the left lateral ventricle was opened, and the second neoplastic lesion was situated also in the direct vicinity of CSF spaces (the Sylvian cistern). For all practical purposes, the case presented testifies to the necessity of intraoperative protection of the CSF spaces by separating any open CSF cisterns from the removed tumor mass with cotton pads. In case of diagnosing cerebral glioma, a possibility of the presence of multiple foci should be taken into account. It is especially important for the differentiation of multiple lesions occurring synchronically, where similarity of radiological features is seen in metastases, cerebral abscesses and demyelinating lesions.