Resorption of Embolic Material in Arteriovenous Malformation (AVM)

Vascular brain lesions have increased risk of intracranial bleeding and, therefore, present a challenge to neurosurgeons attempting surgical resection.  Such tumors may first be embolized prior to surgical excision in order to reduce the risk of bleeding.  Onyx, an ethylene vinyl alcohol copolymer, is one of many embolic agents available to accomplish this task.  Onyx has... Continue Reading →

Malignant Meningitis

The brain is surrounded by several layers of protective coverings collectively called meninges.  The semi-translucent innermost layers, called the leptomeninges, form a "shrink-wrap" around the brain that allows for easy flow of cerebrospinal fluid (CSF) along the outer surface of central nervous system structures. Unfortunately, it also allows for easy spread of neoplastic cells.  The image shows the inferior aspect... Continue Reading →

Myxopapillary Ependymoma: Radiology-Pathology Correlation

Myxopapillary ependymoma arises in the lumbar region of the spinal cord and typically produces symptoms associated with impingement of the spinal nerve roots of the cauda equina. It usually appears as an oval or sausage-shaped contrast-enhancing mass, like the one pictured in this MRI image (sagittal post-contrast T1 Fat-sat).  The myxopapillary ependymoma in the inset photograph represents a gross surgical... Continue Reading →

Secretory Meningioma: A unique Meningioma variant

The secretory subtype of meningioma (pictured here) is just one of many variants of meningioma, a usually histologically benign tumor that arises from the meninges (i.e. the outer coverings overlying the brain) and often contains concentrically-layered calcifications called psammoma bodies.  The secretory variant can be suspected on imaging by the exuberant edema often seen in the adjacent brain tissue.  Microscopically,... Continue Reading →

True Ependymal Rosettes in Ependymoma

The microscopic appearance of ependymomas is dominated by the presence of radially-arranged tumor cells forming rosettes (black arrows), which are named for their resemblance to the flower-like architecture of rose windows in gothic cathedrals.  The perivascular pseudorosette, characterized by tumor cells radially arranged around a central vessel, is more common by far, but it is not specific to... Continue Reading →

Glomus Jugulare Tumor

Glomus jugulare tumor is a slow-growing neoplasm that is often found incidentally. It arises within the jugular foramen of the temporal bone, near the opening of the foramen magnum (the large hole at the base of the skull where the spinal cord and brainstem connect).  The jugular foramen contains the cranial nerves IX, X, and XI and patients will often present with... Continue Reading →

Orbital Meningioma with Radiology-Pathology Correlation

Like the brain, the optic nerve is surrounded by meningeal coverings (called the pia, arachnoid and dura) that can infrequently give rise to a meningioma.  Although often histologically benign, intraorbital meningiomas can cause significant morbidity and blindness due to optic nerve compression.  Surgical removal can be curative, as was the case for this patient, whose tumor exhibited the typical... Continue Reading →

Schwannoma Gross Appearance

Peripheral nerve fibers are sheathed by Schwann cells, which occasionally give rise to a Schwannoma (also termed neurilemoma), a circumscribed tumor that typically occurs along the peripheral aspect of a nerve.  Unlike neurofibromas, schwannomas often can be excised without sacrificing the parent nerve, leaving the patient functionally intact.  Depending on the degree of microscopic microcystic changes, schwannomas can have a soft... Continue Reading →

Spinal Ependymoma: Typical Radiographic Appearance

Ependymal tumors are the third most common primary spinal tumor in adults, after meningiomas and peripheral nerve sheath tumors.  WHO (World Health Organization) Grade II spinal ependymomas, like the one depicted on this sagittal MRI of the cervical spine, have a typical radiographical appearance featuring an intramedullary oval-shaped mass with contrast enhancement.  Ependymomas are often... Continue Reading →

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