title: [Unusual MR appearance of intracranial dissemination from cervical glioblastoma].
abstract: We reported a rare case of cervical glioblastoma with intracranial dissemination at an early stage of clinical course and reviewed the literature. An 8-year-old girl presented with failure of vision 3 months prior to admission to our hospital. Neurological examination on admission disclosed no definitive abnormalities except for bilateral visual disturbance and optic atrophy. Cranial MR images revealed a homogeneously enhancing tumor in the left sylvian fissure. Multiple spotty T2-hyperintensity lesions without contrast enhancement were also disclosed in bilateral cerebellum. Spinal MR images showed an enhancing tumor at C7 and tiny enhancing lesions on the surface of T11. The patient underwent an uneventful excision of the exophytic tumor at C7. The histological diagnosis was glioblastoma. The enhancing tumor in the left sylvian fissure treated by Linac stereotactic radiotherapy with a marginal dose of 38.4Gy in 12 fractions has diminished, whereas the residual tumor at C7 remained unchanged after radiation of 44Gy. In contrast, the multiple spotty lesions without contrast enhancement dispersedly spread in the cerebellum and infiltrated into brain stem despite 4 courses of chemotherapy using ifosfamide, cisplatin, and etoposide. Stereotactic biopsy of the multiple spotty lesions in the cerebellum was performed. Histological examination revealed anaplastic astrocytoma. The patient died 2 weeks after the biopsy despite additional chemotherapy and focal irradiation to the cerebellum. Early detection and selection of optimal therapeutic strategies are important in management of spinal glioblastoma with subarachnoid dissemination, since neuroradiological findings and therapeutic sensitivity are varied according to differentiation of disseminated tumors.
authors.affiliation: Department of Neurosurgery, Akita University School of Medicine, 1-1-1 Hondo, Akita-city 010-8543, Japan. kawashima@nsg.med.akita-u.ac.jp
authors.forename: Ayako
authors.initials: A
authors.lastname: Kawashima
authors.forename: Toshio
authors.initials: T
authors.lastname: Sasajima
authors.forename: Taku
authors.initials: T
authors.lastname: Sugawara
authors.forename: Masataka
authors.initials: M
authors.lastname: Takahashi
authors.forename: Akira
authors.initials: A
authors.lastname: Suzuki
authors.forename: Naoki
authors.initials: N
authors.lastname: Higashiyama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kinouchi
authors.forename: Kazuo
authors.initials: K
authors.lastname: Mizoi
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary*; D002574:Cervical Vertebrae / Q000473:pathology; D002648:Child; D003131:Combined Modality Therapy; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary*; D006801:Humans; D008279:Magnetic Resonance Imaging; D013120:Spinal Cord Neoplasms / Q000473:pathology*