Porwal Mokshal, Kramer Dallas E, Chidambaram Smrithi, Chang Jade, Gyure Kymberly, Chen Douglas, Yu Alexander
Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania.
Department of Otolaryngology, Allegheny Health Network, Pittsburgh, Pennsylvania.
J Neurosurg Case Lessons. 2025 Jul 21;10(3). doi: 10.3171/CASE25179.
Gliosarcomas are rare isocitratedehydrogenase-wildtype glioblastomas characterized by their glial and sacromatous components. A gliosarcoma is primary if the tumor arose de novo and secondary if the tumor arose from a previous glioblastoma. Here, the authors describe a unique case of a secondary gliosarcoma invading the mastoid and affecting the horizontal segment of the facial nerve.
A 69-year-old female presented to the emergency department with 2 weeks of right-sided facial weakness. Six years earlier, she had undergone a gross-total resection for a right temporal glioma and was treated with chemoradiotherapy postoperatively. Pathology confirmed isocitrate dehydrogenase-negative, O6-methylguanine-DNAmethyltransferase-methylated glioblastoma. At current presentation, MRI demonstrated a right temporal tumor that invaded the mastoid. After surgical debulking, the tumor was confirmed to be a secondary gliosarcoma. CT of the temporal bone showed significant tegmen destruction and direct invasion of the horizontal segment of the facial nerve.
Facial weakness was a symptom of the secondary glioscarcoma tumor invading the mastoid and affecting the horizontal segment of the facial nerve. To the authors' knowledge, this symptom has not been previously reported and thus adds to the limited knowledge of secondary gliosarcoma presentations. https://thejns.org/doi/10.3171/CASE25179.
胶质肉瘤是罕见的异柠檬酸脱氢酶野生型胶质母细胞瘤，其特征在于具有胶质和肉瘤成分。如果肿瘤是新发的，则为原发性胶质肉瘤；如果肿瘤由先前的胶质母细胞瘤发展而来，则为继发性胶质肉瘤。在此，作者描述了一例独特的继发性胶质肉瘤病例，该肿瘤侵犯乳突并影响面神经水平段。
一名69岁女性因右侧面部无力2周就诊于急诊科。六年前，她因右侧颞叶胶质瘤接受了全切手术，并在术后接受了放化疗。病理证实为异柠檬酸脱氢酶阴性、O6-甲基鸟嘌呤-DNA甲基转移酶甲基化的胶质母细胞瘤。此次就诊时，MRI显示右侧颞叶肿瘤侵犯乳突。手术减瘤后，肿瘤被证实为继发性胶质肉瘤。颞骨CT显示鼓室盖明显破坏，面神经水平段直接受侵。
面部无力是继发性胶质肉瘤侵犯乳突并影响面神经水平段的症状。据作者所知，该症状此前尚未见报道，因此增加了对继发性胶质肉瘤临床表现的有限认识。https://thejns.org/doi/10.3171/CASE25179
