Abstract
Multiple gliomas are rare glial tumors with a histology that is typically consistent with high-grade gliomas. A distinction is made between multifocal and multicentric gliomas according to criteria of anatomical continuity, as well as between synchronous and metachronous gliomas according to chronological time of onset. We present the case of a professional saxophonist with a left temporoinsular lesion who underwent awake craniotomy with monitoring of verbal and musical ability as well as primary sensory and motor cortices. Histopathological study revealed an isocitrate dehydrogenase 1 (IDH)-mutant diffuse astrocytoma. After 4 years of complete oncological remission, the patient developed impaired proprioception in all four extremities. An intramedullary lesion was detected at the level of C4 consistent with an IDH wild-type diffuse astrocytoma. We highlight the singularity of this case as it involved two low-grade glial lesions, separated in time (metachronous) and location (multicentric), as well as genetic differences between both lesions (IDH mutant and wild type).
Highlights
Multiple gliomas are a relatively rare heterogeneous entity with histology consistent with high-grade gliomas in most cases
Diffuse astrocytoma, classified as grade II according to the WHO classification of tumors of the central nervous system, is characterized by diffuse infiltration of the brain parenchyma, causing swelling and distortion of the anatomical structures affected [1]
Notable among the factors of poor prognosis is multicentricity, most multifocal and multicentric gliomas are associated with more aggressive histologies such as glioblastomas (WHO grade IV) and/or anaplastic astrocytomas (WHO grade III) [5]
Summary
Multiple gliomas are a relatively rare heterogeneous entity with histology consistent with high-grade gliomas in most cases. We present the case of a patient treated for a diffuse left temporoinsular astrocytoma with oncological criteria of complete remission who, three years later, underwent surgery for a low-grade cervical intramedullary astrocytoma. A 27-year-old male saxophonist with no significant medical history presented with absence seizures lasting seconds He was examined in the Neurology Department and referred to Neurosurgery after the detection of a left temporoinsular space-occupying lesion. The patient developed slight left hemiparesis (4/5) from which he recovered in the postoperative period After several months, he continued to experience a slight alteration in proprioceptive sensitivity in all four extremities, which did not prevent him from carrying out his activities as a musician. Cervical MRI 6 months after surgery confirmed complete tumor resection
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