Giant pediatric glioblastoma multiforme causing primary calvarial erosion and sutural diastasis presenting with enlarged head

Abstract

Authors report a rare case of supratentorial glioblastoma multiforme in a 13-year-old boy, who had headache, vomiting and left sided hemiparesis for last 6 months. On evaluation by primary physician he was labeled as hydrocephalus in view of enlarged head with papilledema on fundoscopic evaluation and no imaging was carried out. On current admission, magnetic resonance imaging brain revealed a large heterogeneous mass lesion involving right frontoparietal region associated with massive perilesional edema causing significant mass effect. He underwent right fronto-temporal craniotomy and intraoperatively erosion of parietal bone was observed, unassociated with any extradural deposit of tumor. After surgery, he noticed improvement in headache along with hemiparesis. Primary calvarial erosion in glioblastoma is extremely rare, and there is paucity of literature as evident from the few case reports reported previously and all occurred in elderly, so current case is the first pediatric case having primary calvarial erosion. Management of such case and pertinent literature is briefly discussed.

Keywords: Calvarial destruction; enlarged skull; pediatric glioblastoma multiforme; sutural diastasis.

Figure 1

Large size of head

Figure 2

(a) Noncontrast computed tomography head showing large heterogeneous lesion over right frontoparietal region causing significant mass effect with massive perilesional edema with midline shift of 1.2 cm toward left. (b) Bone window computed tomography head view showing sutural diastases

Figure 3

Magnetic resonance imaging brain (a) T1-weighted image, axial section mass lesion of size measuring 10.8 cm × 5.5 cm × 6.9 cm, heterogeneous with iso to hyperintense with area of cystic degeneration. (b) T2-weighted image, showing heterogeneous mass with areas of hyperintensity such as cerebrospinal fluid intensity with marked perilesional edema. (c) Contrast enhanced magnetic resonance imaging of the brain showing patchy mixed intensity contrast enhancing lesion

Figure 4

Intra-operative photograph: (a) Bone flap showed areas of destruction over parietal and frontal region. (b) Grossly intact dura without evidence of extradural deposit of tumor

Figure 5

Noncontrast computed tomography scan (postoperative) head showed radical excision of lesion with good operative cavity with complete subsidence of midline shift and mass effect