Ly Juan Domingo,  Subramanian Subramanian,  Rajan Deepa,  Greene Stephanie,  Zuccoli Giulio

Final Pr. ID: Poster #: CR-010

An 11-year-old female presented with 3-weeks history of intractable vomiting, nausea, blurred vision, vertical nystagmus and ataxia with gait instability. A CT scan revealed a small calcification at the left craniocervical junction (CJJ) and mild effacement of the fourth ventricle (Figure). MRI showed a partially-enhancing medulla oblongata lesion and a non-enhancing cystic exophytic lesion abutting the left pre-medullary cistern. There was avid thick enhancement along the ventrolateral surface of the medulla oblongata. No restricted diffusion was present. MR spectroscopy demonstrated decreased NAA and elevated lactates. Based on imaging findings, a brainstem glioma with exophytic component was suspected. The CBC, CMP, ESR and CRP were normal. The patient underwent suboccipital craniectomy with C1 laminectomy, and an exophytic pale gray mass was identified. Multiple specimens were taken, and frozen diagnosis showed only necrosis. The cyst wall was resected. Resection of the brainstem component was limited by neurophysiology. Histologically, the lesion consisted of a fibrous cyst wall lined by columnar to pseudostratified columnar epithelium, findings reflecting a neuroenteric cyst. No glial tissue was identified. Gram stain and Grocott stain were negative for bacterial and fungal specimens. An empiric treatment with wide spectrum antibiotic was started. Follow-up MRI demonstrated near complete resolution of edema in the medulla oblongata, and substantial decrease in enhancement in anterolateral exophytic component and patient has substantially improved clinically. In retrospect, a sinus tract extended from the cystic lesion at the craniocervical junction into the brainstem causing edema, inflammation and enhancement which resolved once the cyst was surgically decompressed.

Conclusion:
This case shows a neuroenteric cyst connected to the brainstem, through a sinus tract leading to chronic inflammation and infection, resulting in imaging findings resembling a brainstem glioma. Surgical decompression of the cyst and antibiotic treatment resulted in resolution of the brainstem lesion. Read More

Authors:  Ly Juan Domingo , Subramanian Subramanian , Rajan Deepa , Greene Stephanie , Zuccoli Giulio

Keywords:  Neurenteric, magnetic resonance imaging MRI, glioma

Basavalingu Deepashri,  Perez Francisco

Final Pr. ID: Poster #: CR-019

Herein, we present a case series of children who underwent glial tumor resection with bioabsorbable plates used for craniotomy closure. On follow up MRI as part of tumor surveillance, restricted diffusion was observed in the scalp and extradural space that was initially concerning for tumor recurrence/ seeding. However, after correlation with CT, the sites of restricted diffusion corresponded closely to the sites of bioabsorable plate placement. On additional follow up imaging, the restricted diffusion resolved nearly completely in all patients. Based on literature search and histopathology, we concluded that aforementioned findings are related to delayed inflammatory reaction to the bioabsorbable plates. Read More

Authors:  Basavalingu Deepashri , Perez Francisco

Keywords:  Glioma, Diffusion, Craniotomy

Stein Nina,  Karmur Brij,  Singh Sheila,  Fleming Adam

Final Pr. ID: Poster #: CR-059

Leptomeningeal dissemination (LD) is a common occurrence in primary central nervous system tumours. The most common tumours that develop LD are medulloblastoma, germ cell tumours, and glial tumours. However, in gliomas, this occurrence is rare. It has been reported that only 2-5% of children with low-grade gliomas present with LD. Retrospective review of the Pediatric Brain Tumour Study Group database revealed 4 cases of gliomas with leptomeningeal enhancement at initial presentation: 2 cases of pilocytic astrocytoma, 1 case of glioblastoma multiform in the cervical spinal cord and 1 case of diffuse intrinsic pontine glioma. The presence of LD at initial presentation of gliomas usually indicates poor prognosis, even in cases of pilocytic astrocytoma. Therapeutics also become a chalenge in face of such a rare and diffuse finding. Differential diagnosis should be made imaging wise with possible infectious/inflammatory process giving LD and focal lesions simulating tumors. Identification of LD at initial diagnosis is of major importance for treatment options and prognostication of gliomas in children. Read More

Authors:  Stein Nina , Karmur Brij , Singh Sheila , Fleming Adam

Keywords:  Gliomas, Leptomeningeal disease

Said Yusra,  Pears Jane,  Hayes Roisin

Final Pr. ID: Poster #: SCI-032

We reviewed the MR imaging of all the paediatric patients with optic nerve glioma in our department over the last 15 years in order to determine the frequency of MR Imaging and surveillance which puts significant burden on our imaging department where MRI access is limited especially under general anaesthesia.
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Authors:  Said Yusra , Pears Jane , Hayes Roisin

Keywords:  Optic pathway Glioma, MRI, Pediatric

Scace Candace

Final Pr. ID: Poster #: EDU-077

Brain tumors are the most common solid tumor of childhood and the leading cause of death among all childhood cancers. Because many pediatric brain tumors occur infratentorially, it is important for the radiologist to recognize and distinguish both classic and more rare tumors that can present within this region. The purpose of this presentation is to review the imaging findings associated with the most common posterior fossa tumors in children, discuss their differentiating features, and expand upon this differential by including imaging characteristics of less common, but equally important neoplasms occuring within the posterior fossa. Read More

Authors:  Scace Candace

Keywords:  Infratentorial tumors, Brainstem glioma, Ependymoma, Juvenile pilocytic astrocytoma, Medulloblastoma