Case 2 History, ---- 4 resections: In May 2008, at age 21, this male patient underwent left temporal craniotomy for gross-total resection of an intraventricular tumor at Brigham and Women's Hospital (Specimen 2A). Targeted next generation sequencing of the 2008 tumor (performed in 2017) revealed mutations in PIK3R1, RAD50, and TERT promoter. Subsequently, this patient experienced recurrence and underwent a second resection at a different outside institution in June 2011 (Specimen 2B).The patient received no chemotherapy or radiation with the first two resections. Brain MRI performed in June 2017 showed a slightly enhancing nodule at the ependymal surface of the left lateral ventricle, for which the patient underwent stereotactic needle biopsy (“unremarkable white matter”). Needle biopsy with laser ablation at BJH was subsequently performed (Specimen 2C). In February 2019, the patient was admitted after a witnessed generalized tonic-clonic seizure, which led to a subarachnoid hemorrhage. Follow-up brain MRI on July 2019 showed progressive interval increase in a non-enhancing diffusion restricted heterogeneous mass at the left ventricle trigone. A repeat biopsy in 2019 showed a glioneuronal neoplasm with predominantly glial component, BRAF altered, with targeted sequencing demonstrating mutations in BCORL1, PIK3R1 and TERT promoter, and CDKN2A/B loss. Recent follow up imaging in 2020 revealed an enlarging mass at the inferior aspect of prior resection bed, concerning for recurrent disease. Operative procedure: Left parietal twist drill burr hole for frameless stereotactic needle biopsy and laser interstitial thermal therapy of recurrent tumor.
