title: Multicentric spinal cord and brain glioblastoma without previous craniotomy.
abstract: BACKGROUND
  Glioblastoma multiforme (GBS) is a highly malignant glioma that rarely presents as an infratentorial tumor. Multicentric gliomas lesions are widely separated in site and/or time and its incidence has been reported between 0.15 and 10%. Multicentric gliomas involving supratentorial and infratentorial region are even more rare. In most cases, infratentorial disease is seen after surgical manipulation or radiation therapy and is usually located in the cerebellum or cervical region.
  
  
  METHODS
  We present a rare case of symptomatic multicentric glioma in the brain, fourth ventricle, cervical as well as lumbar glioblastoma in an adult without previous therapeutic intervention. We also review the literature of this rare presentation.
  
  
  CONCLUSIONS
  This report suggests that GBM is a diffuse disease; the more extended the disease, the worse prognosis it has. The management still remains controversial and further studies are required to understand the prognosis factors of dissemination.
authors: Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Sayoa A
authors: SA
authors: de Eulate-Beramendi
authors: Department of Neurosurgery, Hospital Universitario Joan XXIII, Tarragona, Spain.
authors: Kelvin M
authors: KM
authors: Piña-Batista
authors: Department of Neurosurgery, Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain.
authors: Victor
authors: V
authors: Rodrigo
authors: Department of Anatomopathology, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Hector E
authors: HE
authors: Torres-Rivas
authors: Department of Neurosurgery, Hospital Universitario Central de Asturias, Oviedo, Spain.
authors: Juan C
authors: JC
authors: Rial-Basalo
keywords: Brain glioblastoma; muticentric glioblastoma; spinal glioblastoma; surgery