Multicentric gliomas are well-separated lesions, located in different lobes or hemispheres, which cannot be ascribed to dissemination through commissural pathways: cerebrospinal fluid, blood, or local extension. The aim of presenting this case was to highlight the management dilemmas of bilateral parieto-occipital region oligodendroglioma in mirror image fashion. A 38-year-old male presented with holocranial headaches and visual seizures for 3-month duration. He had no neurological deficits. Computed tomography scan of the brain revealed hypodense space-occupying lesions with calcification in the bilateral parieto-occipital region in a mirror-image fashion. His magnetic resonance imaging scan of the brain with gadolinium study revealed ill-defined nonenhancing, T2-weighted image heterointense lesion with cystic spaces without significant restricted diffusion, in the bilateral parieto-occipital region with underlying edema extending to the corpus callosum. Patient underwent staged surgery 2 weeks apart. Both stages involved navigation guided parieto-occipital craniotomy and gross total excision of the parieto-occipital lesion. His postoperative visual field assessment after surgery showed a right and left eye inferior quadrant field defect with normal visual acuity in other quadrants, which remained stable after the second surgery. On both sides, the histopathological report was oligodendroglioma World Health Organization Grade II. Multicentric mirror image oligodendrogliomas involving the bilateral parieto-occipital region are extremely rare. Tissue diagnosis should be attempted from all accessible lesions in view of histological heterogeneity. Maximal safe resection of both lesions may be a reasonable strategy in this group of patients.
Symss et al. (Thu,) studied this question.