Diagnosis of Infantile Hemispheric Glioma via Combined (Pre- and Intraoperative) Neuronavigation: Case Study

Background. Infantile hemispheric glioma (IHG) is a glial tumor (often large sized) that often develops in utero or during infancy. Timely diagnosis is challenging due to its rarity in young children and the variability of its molecular genetic characteristics. Implementation of preoperative and intraoperative neuroimaging allows to remove the most morphologically significant areas of tumor tissue when total resection is not possible, while cytogenetic analysis allows for a definitive diagnosis.

Case description. The child with intrauterine growth retardation has grade 2 cerebral ischemia and movement disorders syndrome. Neurosonography at 13 days of age has revealed large cystic lesion that was not identified as a tumor. An increase in head circumference up to 7 cm was noted at the age of 2.5 months, while neurosonography has shown enlargement of the cystic cavity in the left hemisphere, thus ventriculoperitoneal shunting was performed. Magnetic resonance imaging of the brain has revealed a large cystic and solid lesion in the left hemisphere at the age of 8 months. We used combined neuronavigation to establish the diagnosis and determine treatment tactics: preoperative positron emission tomography with [¹⁸F]fluoroethyl-l-tyrosine combined with computed tomography and ultrasound and fluorescence guidance during the surgery. Tumor cytogenetic analysis was performed and confirmed the glial nature of the neoplasm.

Conclusion. This case shows the complexity of IHG diagnosis and the benefits of preoperative and intraoperative neuronavigation, as well as cytogenetic testing, to establish the final diagnosis.

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