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What Does "Left Cerebellar Hemisphere Shows Heterogeneous Mass Lesion" Mean?

Posted on Sat, 1 Mar 2014

Question: Is Retromastoid craniectomy is mandatory for below MRI report Please find below the details of MRI Left cerebellar hemisphere shows heterogeneous mass lesion with surrounding hyperintensity in T2/Flair sequence. The lesion measuring 43x23x19 mm (RLXAPXCC) The lesion shows heterogeneous enhancement with irregular prominent enhancement of the margins. The adjacent left sigmoid and tranverse sinuses show increased signal intensity. The fourth ventricle is compressed and deviated towards right side Subtle tonsilar herniation seen in the left side Impression: Hetrogeneously irregular marginal enhancing mass lesion in left cerebellum with mass effect on the fourth ventricle, perilesional edema and minimal tonsilar herniation. No flow seen in the left sigmoid and transverse sinuses - suggestive of thrombosis Bilateral mastoiditis.

Answered by Dr. Indu Kumar (1 hour later)

Brief Answer: Yes,craniotomy is necessary for biopsy or surgery. Detailed Answer: Hello XXXX Thanks for writing to us Patient is suffering from brain tumour in left cerebellar hemisphere and tumour mass is causing compressive effects.This is indicated by compression over 4th ventricle. Before considering for definitive treatment,probably neurosurgeon is considering for biopsy of the lesion so that exact treatment can be done.If biopsy shows malignant cells then excision of mass can be done.Craniotomy is necessary for assess to the mass. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (5 minutes later)

Thank you very much for your prompt reply. But, MRI suggests Thrombosis. Despite Thrombosis, surgery has to be taken place for mass removal. Also, neuro surgeon opts Retromastoid craniectomy not cranitomy. Is it possible to cure by medication or surgery is mandatory to know the reason. Even if it is infarkt, surgery is required. Infarction can be indentified by MRI or Biopsy. Please help. Thanks, XXXX

Answered by Dr. Indu Kumar (13 minutes later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXX Thanks for writing back Your neurosurgeon is considering for definitive surgery.Most of the brain tumours are treated by surgery.Thrombosis is due to tumour.Surgery can be done even with thrombosis. Now a days we are more confirmed about nature of mass due to technology MR spectroscopy. Lesion is not due to infarct.Infarct shows different picture and it can be easily diagnosed by MRI.For infarct biopsy is not needed at all. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Indu Kumar (23 minutes later)

Dr XXXXXXX Bhusan, Please be informed that they have done the surgery on urgent basis. But, it is not a tumour, it is a hemmoraghic infarction due to CVT. Patient is fine. But, my query, is surgery required. Doctor has opined that we have done due to benefit of doubt to the patient and there is a mass effect and it may be fatal. But other doctors opinion MRI states thrombosis and they would have suspected for infarkt and cured medically. Please clarify.

Answered by Dr. Indu Kumar (4 hours later)

Brief Answer: Please find detail answer below. Detailed Answer: Hello XXXX Thanks for writing back Surgery may be done if there is diagnostic dilemma and patient vital signs are compromised. MRI spectroscopy finding could had been give more information to differentiate it between tumour or hemorrhagic infarct. There must be some precipitating factor for sinus thrombosis.It is relatively rare cause for infarct and thrombosis can occur due to many reasons including cancer. Get well soon. Hope i have answered your query. Further queries are most welcome. Take Care Dr.Indu XXXXXXX

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar