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Robert C. Rennert, Vance L. Fredrickson, Vance R. Mortimer, William T. Couldwell
  1. Department of Neurosurgery, University of Utah, Clinical Neurosciences Center, Salt Lake City, United States

Correspondence Address:
William T. Couldwell, Department of Neurosurgery, University of Utah, Clinical Neurosciences Center, Salt Lake City, United States.

DOI:10.25259/SNI_812_2024

Copyright: © 2025 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, transform, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

How to cite this article: Robert C. Rennert, Vance L. Fredrickson, Vance R. Mortimer, William T. Couldwell. Staged and combined resection of a posterior fossa ganglioglioma. 31-Jan-2025;16:29

How to cite this URL: Robert C. Rennert, Vance L. Fredrickson, Vance R. Mortimer, William T. Couldwell. Staged and combined resection of a posterior fossa ganglioglioma. 31-Jan-2025;16:29. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=13356

Date of Submission
26-Sep-2024

Date of Acceptance
08-Jan-2025

Date of Web Publication
31-Jan-2025

Abstract

Background: Posterior fossa gangliogliomas with extension into the cerebellopontine angle are extremely rare and can be challenging to resect because they are infiltrative and the regional neurovasculature is complex.[1,2] Tumor grade may best predict oncologic outcome.[1] Histologic grading can be used to balance surgical aggression with the risk of cranial neuropathies.

Case Description: During an evaluation for headaches, a 19-year-old woman was found to have a 5.3 × 4.0 × 3.5-cm left lateral cerebellar and cerebellopontine angle tumor, with an apparent intrinsic origin and significant exophytic extension. The lesion was minimally enhancing and partially cystic and had significant calcifications. On examination, she was neurologically intact, with the exception of mildly decreased left oropharyngeal sensation. She underwent a left retrosigmoid craniotomy for tumor debulking and tissue diagnosis; the tumor was found to be adherent to cranial nerves 7 through 11. Pathological evaluation demonstrated a ganglioglioma (World Health Organization grade I). A safe maximal resection was recommended on multidisciplinary review. A secondary left far lateral craniotomy and C1 hemilaminectomy were performed, allowing for a complete resection of the residual tumor. The patient was discharged on postoperative day 6 at her neurologic baseline, with the exception of new mild left V2–3 paresthesias that were resolved by 6-month follow-up. Postoperative and 6-month magnetic resonance imaging demonstrated a gross total resection with no complications.

Conclusion: For rare, low-grade tumors, a staged, histology-guided, safe maximal resection can maximize functional and oncologic outcomes.

Keywords: Ganglioglioma, Far lateral craniotomy, Cerebellopontine angle

Video 1

Video Annotations[1,2]

0:06 – Patient history

0:12 – Preoperative imaging

0:47 – Stage 1 surgery

3:05 – Postoperative stage 1 imaging

3:16 – Postoperative stage 1 summary

3:22 – Stage 2 surgery

6:32 – Postoperative stage 2 imaging

6:48 – Postoperative stage 2 summary.

Ethical approval

Institutional Review Board approval is not required.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Video Available on

www.surgicalneurologyint.com

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

References

1. Boissonneau S, Terrier LM, De La Rosa Morilla S, Troude L, Lavieille JP, Roche PH. Cerebellopontine angle gangliogliomas: Report of two cases. Neurochirurgie. 2016. 62: 266-70

2. Kwon JW, Kim IO, Cheon JE, Kim WS, Chi JS, Wang KC. Cerebellopontine angle ganglioglioma: MR findings. AJNR Am J Neuroradiol. 2001. 22: 1377-9

1 Comments

    avtar image
    eric nussbaum

    Posted February 4, 2025, 11:21 am

    really nice case. well done. appreciate the thoughtful approach.

    Reply

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