Intra-Axial Brain Tumors and Gliomas — WACS Viva & Clinical Scenarios (Neuro-Oncology and Skull Base Disorders)

Exam-style intra-axial brain tumors and gliomas viva scenarios with examiner probes and model answers for Neurosurgery candidates.

Scenarios covered

• SCENARIO 1: A 54-year-old male presents with a 4-week history of progressive early morning headaches, cognitive slowing, new-onset focal motor seizures involving the right upper limb, and a pronator drift. Contrast-enhanced brain MRI reveals a 4.5 cm ring-enhancing mass in the left posterior frontal lobe with central necrosis and marked peritumoral vasogenic edema. Detail your preoperative diagnostic workup, surgical planning including considerations for maximal safe resection in eloquent cortex, and postoperative adjuvant management based on modern molecular pathology.
• SCENARIO 2: Outline the 2021 World Health Organization (WHO) classification system for diffuse adult gliomas. Explain the clinical and prognostic significance of IDH1/IDH2 mutation status, 1p/19q co-deletion, ATRX expression, and MGMT promoter methylation in guiding therapeutic stratification.
• SCENARIO 3: A 42-year-old schoolteacher presents with speech arrest and low-grade seizures. Magnetic resonance imaging demonstrates a non-enhancing, T2/FLAIR hyperintense intra-axial lesion centered within the left inferior frontal gyrus (Broca area). Discuss the indications, patient selection criteria, preoperative preparation, and surgical protocol for an awake craniotomy with intraoperative cortical and subcortical functional mapping.
• SCENARIO 4: A 62-year-old woman is found to have multiple enhancing intra-axial cerebral and cerebellar lesions on contrast MRI. Outline the diagnostic algorithm to identify the primary pathology, contrast the surgical indications for brain metastases versus primary central nervous system lymphoma (PCNSL), and explain why pre-biopsy corticosteroids may compromise diagnostic yield in suspected lymphoma.
• SCENARIO 5: A 35-year-old male with a known right temporal glioblastoma awaiting elective surgery suffers acute neurological deterioration in the neurosurgical ward, developing a Glasgow Coma Scale drop from 14 to 7 with an ipsilateral fixed, dilated pupil. Detail your immediate step-by-step emergency resuscitation, medical brain-specific therapies, and urgent surgical decision-making.