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Case Study of an Unusual Intracranial Mesenchymal Neoplasm
Camille Carlisle1, Alexandra Lesko2, Vassil Kaimaktchiev3
1College of Osteopathic Medicine of the Pacific Northwest, Western University of Health Sciences, Lebanon, Oregon, USA.
Background And Importance:
A 51-year-old woman with multiple sclerosis (MS) presented for MS management and follow-up, including repeat MRIs. On imaging, a slowly growing enhancing lesion was noted in the left posterior insula. Histopathology reported this tumor as a low-grade mesenchymal neoplasm, not elsewhere classified. The case reported here will add to the library of central nervous system tumors, which may help identify other previously unclassifiable tumors.
Clinical Presentation:
The lesion was inconsistent with MS plaques, and MRI and computed tomography angiography showed no signs of aneurysm. After evaluation, we recommended surgery to remove the lesion. Surgical excision posed a challenge as the dominant hemisphere posterior insula can be difficult to access. We used a trans-sylvian approach, sparing vasculature within the sylvian fissure with clean excisional margins. The trans-sylvian approach enabled minimal manipulation of brain tissue surrounding the lesion, including the receptive speech center. The patient recovered without complications. Postsurgical follow-up revealed no new neurological symptoms or deficits and no sign of tumor recurrence.
Conclusion:
The trans-sylvian approach we used to excise the tumor resulted in a favorable outcome for the patient. This case supports that the trans-sylvian approach, while technically more demanding, is feasible and potentially beneficial.
