Gliosarcoma with extension to infratemporal fossa and ventricle

Abstract

Summary Gliosarcomas are bimorphic intra-axial tumors. They rarely involve both the skull base and ventricles simultaneously. A case of temporal lobe gliosarcoma with significant infratemporal fossa and lateral ventricle extension is reported. The patient, an 82-year-old man, had gradual general weakness and a poor response to speech for 3 weeks. Neurological examination was unremarkable except for poor awareness and myoclonic jerks. Magnetic resonance imaging revealed a 72-cm3 right temporal mass with extension into the infratemporal fossa and the wall of the temporal horn of the lateral ventricle, and consisted of intra-axial and extracranial components with extension to the cavernous sinus, dura, temporal bone, and sphenoid ridge. The patient underwent a right-sided craniotomy through the orbitozygomatic approach. Gross total resection was achieved. The histopathological diagnosis was gliosarcoma. Fractional whole-brain radiation and chemotherapy with temozolomide were administered subsequently. However, the tumor recurred 1.5 months after his initial treatment, and the survival time was 9.2 months. In the case of a mass lesion with both intra-axial and extracranial involvement, the simultaneous involvement of both the skull base and ventricles is highly unexpected, and gliosarcoma should be included in the differential diagnoses of brain tumors. The overall treatment and outcome will be difficult to determine if the skull base and ventricles are both involved. An extensive multimodality treatment might be effective in patients with gliosarcomas according to a review of the literature. The recurrence-free time of gliosarcoma with skull base extension ranges from 2 months to 12 months, and for gliosarcoma with ventricular extension, it ranges from 1.5 months to 2 months. The survival time of gliosarcoma with skull base extension ranges from 7 months to 22 months, and with ventricular extension, it ranges from 0.33 months to 9.2 months. Gliosarcoma with ventricular involvement might be a poor prognostic factor, and may help in the prediction of recurrence-free and survival time.