Please help evaluate the urgency of tumor relapse (gliosarcoma GIV)

Dear all,


I need your advise and support.

My sister has gliosarcoma GIV (please see our medical history here). Last MRI figured out relapse of tumor growth. How evaluate property real level of urgency and real speed of tumor growth?

Links for MRIs are here

Should we look for the option of another surgery  (rejection)? Is there any chance to do it without trepanation of skull? I heard this may be done with ultrasound. What are the best options for surgery?

Thanks in advance for your help and recommendations.

22.11.2019 MRI 

MR scanner: "Philips Achieve ЗТ x-series"

MRI: Brain Inspection Protocol with intravenous Gadovist Contrast enhancement

Midline structures: not displaced.

Brain matter: the state after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma).

According to the postoperative bone flap in the brain parenchyma residual cystic changes in the occipitoparietal region of 15x17x219 mm and 21x13x19 mm in the occipital region with low intensive signal in the modes: on T2 33, T2 FLAIR are visualized.

After intravenous injection of contrast, the accumulation of contrast in the form of a 2-3 mm thick non-uniform thin strip along the contour of the postoperative defect due to granulation changes, perifocal edema of 5 mm were visualized. 

The cerebellum structure is not changed. The differentiation of gray and white matter of the brain is not impaired. Parahippocampalis gyri, hippocampi are without space-focal changes. The structures of the basal nuclei are differentiated, the inner and outer capsules are not altered.

Ventricular system: anterior horns of lateral ventricles: left 7.8 mm, right 7.1 mm, 3rd ventricle 5.0 mm, cerebral cisterns are expanded.

Chiasmosellar region: extension of suprasellar cistern, pituitary 10x5 mm.

Craniovertebral junction: unchanged, the cerebellar tonsils are located at the level of the occipital foramen.

Convexital subarachnoid spaces: extended to 3 mm.

Orbital cones, optic nerves: unchanged.

Paranasal sinuses: of satisfactory pneumatization.

Conclusion: condition after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma) in the form of cystic gliotic changes. Accumulation of contrast with a 2-3 mm thick non-uniform thin strip along the contour of the postoperative defect is visualized.

18.12. 2019 MRI 

"Philips Achieve ЗТ x-series"

MRI: Brain Inspection Protocol

with intravenous Gadovist Contrast enhancement

Midline structures: not displaced.

Brain matter: the state after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma).

According to the postoperative bone flap in the brain parenchyma residual cystic changes in the occipitoparietal region of 15x17x219 mm and 21x13x19 mm in the occipital region with low intensive signal in the modes: on T2 33, T2 FLAIR are visualized.

After intravenous injection of contrast, the accumulation of contrast in the form of a 4-5 mm thick strip along the contour of the postoperative defect, perifocal edema of 5 mm were visualized. In occipital lobe, a focus is visualized convexitally, which accumulates contrast 6.9x5.6x8.2 mm in size. In left occipitotemporal region, the non-uniform thickening of meninges up to 2-3 mm is defined. Regions of accumulation of contrast 7-8 mm in size in the area of postoperative access.

The cerebellum structure is not changed. Parahippocampalis gyri, hippocampi are without space-focal changes. The structures of the basal nuclei are differentiated, the inner and outer capsules are not altered.

Ventricular system: anterior horns of lateral ventricles: left 7.5 mm, right 7.9 mm, 3rd ventricle 5.0 mm, cerebral cisterns are expanded.

Chiasmosellar region: extension of suprasellar cistern, pituitary 10x5 mm.

Craniovertebral junction: unchanged, the cerebellar tonsils are located at the level of the occipital foramen.

Convexital subarachnoid spaces: extended to 3 mm.

Orbital cones, optic nerves: unchanged.

Paranasal sinuses: of satisfactory pneumatization.

Conclusion: condition after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma), cystic gliotic postoperative changes, negative changes, continuous neoplasm growth along the periphery of the postoperative defect and focus of left occipital lobe.

20 01 2020 MRI 

"Philips Achieve ЗТ x-series"

MRI: Brain Inspection Protocol

with intravenous Gadovist Contrast enhancement

Midline structures: not displaced.

Brain matter: the condition after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma), condition after chemotherapy. 

According to the postoperative bone flap, in parenchyma of occipitoparietal region of brain, cyst with low intensive signal in the modes: on T2 33, T2 FLAIR of 15x16.1x15.6 mm with septum and non-uniform hemorrhagic content is visualized. Accumulation of contrast in the form of a 3-4 mm thick strip along the contour of the cyst, perifocal edema of up to 7-8 mm are visualized.

Residual cystic changes in occipital region of 28x14x16mm, after intravenous injection of contrast, the accumulation of contrast in the form of a 4 mm thick strip along the contour of the postoperative defect, perifocal edema of 8 mm are visualized. In occipital lobe, a focus is visualized convexitally, which accumulates contrast 8x9.4x10 mm in size, with perifocal edema of 5-6 mm (prior size) 6.9x5.6x8.2. 

In left occipitotemporal region, the non-uniform thickening of meninges up to 2-3 mm is defined. Regions of accumulation of contrast 7-8 mm in size in the area of postoperative access.

The cerebellum structure is not changed. Parahippocampalis gyri, hippocampi are without space-focal changes. The structures of the basal nuclei are differentiated, the inner and outer capsules are not altered.

Ventricular system: anterior horns of lateral ventricles: left 8.2 mm, right 6.9 mm, 3rd ventricle 6.0 mm, cerebral cisterns are expanded.

Chiasmosellar region: extension of suprasellar cistern, pituitary 10x5 mm.

Craniovertebral junction: unchanged, the cerebellar tonsils are located at the level of the occipital foramen.

Convexital subarachnoid spaces: extended to 3 mm.

Orbital cones, optic nerves: unchanged.

Paranasal sinuses: of satisfactory pneumatization.

Conclusion: condition after osteoplastic craniotomy, surgical treatment of intracerebral neoplasm of the left temporoparietal-occipital region as of August 7, 2019 (WHO Grade IV glioma), after chemotherapy, cystic gliotic postoperative changes, continuous neoplasm growth along the periphery of the postoperative defect and focus of left occipital lobe with relatively stable MRI results compared to the data as of December 18, 2019.