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Glioblastoma multiforme mimicking a frontal abscess after surgery for a large vestibular schwannoma
C Fuchsmann1, A Traverse-Glehen, M Durbec
1Département d'otoneurochirurgie, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France.
Objectives:
Routine vestibular schwannoma surgery can result in serious and potentially lethal infectious complications. A high degree of vigilance is necessary to diagnose these uncommon infections and in case of postoperative neurological symptoms, brain magnetic resonance imaging should be performed to eliminate a brain abscess. In some cases, the final diagnosis is not the expected one.
Clinical Presentation:
A 39-year-old man presented three months postoperatively after a vestibular schwannoma removal by translabyrinthin approach with a rapid and progressive history of headaches, confusion, and left hemi paresis with fever. The brain CT and MRI were in favour of a delayed postoperative frontal abscess.
Technique:
A biopsy under stereotactic guidance was performed. Histopathologic examination revealed WHO grade 4 glioblastoma multiforme.
Conclusion:
Symptoms and signs of glioblastoma multiforme are congruent with brain abscess. Its rapid evolution, the normality of the first magnetic resonance imaging, and its radiological aspect made it a differential diagnosis of a postoperative brain abscess and should be systematically researched.
Insights
Postoperative vestibular schwannoma patients may develop glioblastoma mimicking brain abscess. Early diagnosis requires vigilance for this rare but serious complication, even with initial normal imaging.
Area of Science:
- Neurosurgery
- Neuropathology
- Neuroradiology
Background:
- Vestibular schwannoma surgery carries risks of serious infectious complications.
- Postoperative neurological symptoms necessitate prompt investigation, including brain imaging, to rule out abscess.
Observation:
- A patient presented with symptoms suggestive of a delayed postoperative brain abscess after vestibular schwannoma removal.
- Initial CT and MRI scans indicated a frontal abscess.
Findings:
- Stereotactic biopsy revealed WHO grade 4 glioblastoma multiforme, not an abscess.
- Glioblastoma symptoms and imaging characteristics can closely resemble brain abscess.
Implications:
- Glioblastoma should be considered in the differential diagnosis of postoperative brain abscesses.
- Systematic investigation is crucial when clinical presentation and imaging are atypical for expected complications.
