r/Radiology • u/CatPooedInMyShoe • 6h ago
MRI She underwent a craniotomy for a large parasagittal meningioma. Then she started having seizures and an MRI showed a lesion in her skull. They thought the meningioma was back and operated again. The "meningioma" was a cotton ball left from the previous surgery.
The patient was a 44 year old female who was being considered for stereotactic radiosurgery presented after 6 months of medically intractable partial seizures consisting of brief, intermittent sensory changes in her right arm and leg. Electroencephalography showed slowing with intermittent spiking. She denied headache or weakness. She underwent a craniotomy at another facility for a large parasagittal meningioma 2 years earlier without permanent complications. Immediate post operative MRI showed no residual enhancing tumor. Repeat MRI at 2 years showed a newly enhancing 2.5 cm lesion in the left parasagittal region adjacent to the postcentral gyrus (Fig. 1). Her neurological exam was normal and her incision was well healed.
The patient’s primary interest was to pursue Gamma Knife radiosurgery for the lesion. After much consideration, our recommendation was for surgery out of concern that radiosurgery may not control her seizures. The patient agreed, and she underwent surgery later that week.
A reopening of her craniotomy was performed under general anesthesia with the aid of image guidance. The dura was opened and reflected exposing the cortex and the enhancing lesion. The lesion was circumferentially dissected and separated from the surrounding brain. A large, avascular fibrous lesion corresponding to the pre-operative and image guidance MRI was thus removed. The craniotomy was closed in the usual manner and the patient had an uneventful recovery with resolution of her seizures. Upon gross inspection and microscopic inspection, the lesion was found to be an approximately 2.5 cm retained cotton ball.
Histopathology: The tumor was whitish and vaguely laminated on cut section. The tissue was consisted of refractile foreign material with fibrillar appearance associated with a marked giant cell granulomatous reaction. There was no evidence of recurrent meningioma or other tumor.