Male, 59 years old, with brain mass. Preoperative assessment and planning exam is required. A large centrally necrotic and rim-enhancing mass is present occupying the entire right anterior temporal lobe with extension superiorly to involve the insula and the corona radiata. This lesion measures 63 x 47 mm in the axial plane and 48 mm in the craniocaudal dimension. The lesion is mildly hemosiderin stained internally.The lesion is in contact with the right lateral ventricular atrium and there is clear subependymal enhancement along the atrium. No definite contralateral enhancement or masslike signal abnormality is seen.The lesion exerts significant regional mass effect with sulcal effacement and midline shift to the left of up to 10 mm. The right lateral ventricle is effaced. The right uncus is medialized, but the basal cisterns are otherwise patent. Extensive T2 signal abnormality spreads superiorly and posteriorly from the lesion reaching the right occipital lobe, the basal ganglia and the right frontal and parietal centrum semiovale.No other significant parenchymal signal abnormality is seen. The left lateral ventricle is slightly prominent but this likely reflects atrophy rather than entrapment. The cerebellum shows evidence of volume loss.
A large rim-enhancing right temporal lobe mass is seen with extension superiorly to involve the insula and corona radiata. The mass contacts the right ventricular atrium and there is evidence of subependymal spread. Significant regional mass effect is also seen.