A 19-year-old male was referred for a blurred vision and eyestrain associated with occipital headache for several weeks. Ophthalmologic examination showed left homonymous hemianopia and papilledema on fundoscopy. The CT scan showed a 7 cm diameter lobulated hyperdense mass with calcifications. On MRI, the lesion was hyperintense on T2 and hypointense on T1 weighted images with moderate gadolinium enhancement. The lesion was well demarcated and laid on tentorium. Diffusion weighted imaging did not exhibit restriction (High apparent diffusion coefficient (ADC)). Surrounding brain parenchyma was normal (Figure 1a). The lesion was hypoperfused when compared with normal brain (Figure 1b). MRI spectroscopy (Figure 1c) showed a high choline to creatinine ratio (suggesting high cell membrane turn over) and elevated lipids and NAA. The lesion was totally removed via a right parietal craniotomy. Intraoperatively, the lesion was readily visible at the surface of the brain, firm, with a clear dissection plan. It was inserted on the falx cerebri and the tentorium. Gross examination showed a firm lobulated white lesion (Figure 1d). There was no evidence of hemorrhage or necrosis.
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