PROBLEMI DIAGNOSTICI. I CASI DI NEURORADIOLOGIA DEL JOHNS HOPKINS HOSPITAL

The MRI study of a patient with a large mass originating from the ponto-medullary junction and extending in an exophytic fashion into the foramen magnum and upper spinal cord have been presented. The differential diagnosis includes astrocytoma, ependymoma, subependymoma and choroid plexus papilloma. Less likely possibilities would include meningioma and epidermoid which have differing signal characteristics. Two days after surgery a post-Gd TWI MRI confirmed the complete surgical resection of an ependymoma arising from the floor of the 4th ventricle and extending into the subarachnoid spaces through the foramina of Magendie and Luschka. The prognosis of a completely resected well differentiated ependymoma confirmed by post-operative MRI is good. Adjuvant therapy in the form of radiotherapy or chemotherapy is not recommended. The patient returned to his job six weeks after surgery and he will be followed with MRI yearly.