Dural Metastases of a Glioblastoma
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Correspondence
Dural Metastases of a Glioblastoma M. Lettau · P. Jedrusik · M. Laible
Received: 23 October 2012 / Accepted: 10 December 2012 © Springer-Verlag Berlin Heidelberg 2012
Introduction Glioblastoma multiforme (GBM) is the most common malign brain tumor of the adult. Whereas its spread is diffusely infiltrative, metastases are very rare. They are present in less than 2 % of all patients [1]. In most cases, those are leptomeningeal metastases, which are transported via cerebrospinal fluid (CSF). In the following, we report a patient with a glioblastoma who developed intracranial dural (pachymeningeal) metastases in multiple locations. Case Report In our patient, a tumor of the left temporopolar region was diagnosed after several episodes of disturbance of speech at the age of 80 years (Fig. 1). The tumor’s histological diagnosis was GBM WHO grade IV. Macroscopic, it was completely resected. Thereafter, an adjuvant radiation was conducted. Three months postoperative, the patient complained about fatigue. On magnetic resonance imaging (MRI), there was an extensive subdural hygroma over the left frontoparietal region with a thickness of 12 mm M. Lettau, MD () · P. Jedrusik, MD Division of Neuroradiology, Department of Neurosurgery, University of Freiburg Medical Center, Breisacher Straße 64, 79106 Freiburg, Germany e-mail: [email protected] M. Laible, MD Department of Neurology, University of Freiburg Medical Center, Breisacher Straße 64, 79106 Freiburg, Germany M. Laible, MD Department of Neurology, University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
Fig. 1 Axial T1-weighted image with fat suppression after contrast administration. A left temporopolar GBM was diagnosed
(Fig. 2). The hygroma was treated by burr hole trepanation on the left parietal area. A catheter was placed there, draining 300 ml cerebrospinal fluid each day. Both, the symptoms and the thickness of the mentioned subdural hygroma, had not changed after 3 days. Therefore, the catheter was removed. Because of a circumscriptive MRIcontrast enhancement at the borders of the temporal resection cavity, an adjuvant chemotherapy with temozolomide at a dose of 150 mg/m2 body surface was induced. Seven months postoperative, while the forth cycle of temozolomide chemotherapy was administered, the patient recognized a worsening of his general comfort. Besides a small local recurrence of the GBM at the dorsal resection border on brain MRI, we found multiple dural tumors in various supra- and infratentorial localizations (Fig. 3). A follow-up MRI was conducted 6 weeks later and revealed a growth of the tumor masses (Fig. 4). For histological examination, an operative exploration of one of the tumors at the right parietal lobe was conducted. It was an extracerebral tumor with adherence to the dura mater and infiltration of the arachnoid mater. Histological results again showed a GBM WHO grade IV.
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Fig. 2 Axial T1-weighted image with fat suppression after contrast administratio
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