Metastatic Tumor, unknown primary- pathology suggestive of adenocarcinoma

Patient: 48 yr-old right handed female who is a college professor, presented for evaluation of a 4cm lesion found on MRI scan located in the left atrium of the lateral ventricle and posterior thalamus.

Presenting Problem: She presented with visual symptoms for over a month, and was found to have a homonymous hemianopsia. Patient also reported difficulties with headaches of increased frequency. Fellow workers noted a difference in her performance and mental status changes.

Treatment: She underwent a craniotomy for resection of this lesion. Subtotal resection was performed in part in an effort to preserve thalmic and other deep brain structures.

Postoperatively she had some worsening of her field cut, but otherwise is in good neurological condition. The work up for primary lesion had been unrevealing. After reviewing the indications, alternatives and risks, the patient and family opted to proceed with Gamma Knife radiosurgery for the residual tumor. One month after subtotal resection the patient received the treatment.

The Leksell frame was placed and MRI and CT scans were obtained. Using the digital information of the scans and the Leksell Gamma plan software, a treatment plan was devised. 15 shots with the 8mm. collimator were prescribed with 98% coverage at the 50% isodose line which a prescription dose of 20 Gy was delivered.

Clinical Outcome: After completion of the procedure, the patient was monitored and discharged to home shortly after. The patient has been followed with repeat MRIs every 3 to 4 months and at 14 months continues to do well.

A primary has yet to be identified. She continues to teach at the university. She has some subtle memory difficulties but denies any change in her vision, and does not report any significant difficulties with headaches. She occasionally has a twinge of pain in the craniotomy region.

Review of the MRI scan demonstrates the postsurgical change from her prior craniotomy. A small focus of enhancement in the atrium of the left lateral ventricle. This is similar if not slightly diminished in comparison with her prior MRI scans. No other intracranial lesions are identified to date. Patient will continue to be monitored by periodic MRI and Ct studies.