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Hernandez NS, Nguyen A, Vance AZ. Ventricular Migration of Vitreous Silicone Oil Masquerading as a Ruptured Colloid Cyst. Cureus 2024; 16:e58043. [PMID: 38738078 PMCID: PMC11088469 DOI: 10.7759/cureus.58043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
The ventricular migration of vitreous silicone oil (SiO) is rare and can easily be mistaken for intraventricular hemorrhage or a ruptured colloid cyst. We report here the case of an adult male who was misdiagnosed with a ruptured colloid cyst and was subsequently found to have ventricular migration of vitreous SiO. A 57-year-old male presented unresponsive following a respiratory arrest and underwent a head computed tomography (CT) scan that demonstrated multiple ovoid hyperdensities in the ventricular system, which was concerning for a ruptured colloid cyst. He was transferred to our institution for neurosurgical evaluation. Magnetic resonance imaging (MRI) was performed and demonstrated widespread abnormal diffusion restriction throughout the cortex and basal ganglia, consistent with anoxic brain injury secondary to hypoxic respiratory arrest. The MRI also demonstrated an abnormal signal in areas corresponding with the previously identified intraventricular lesions, which did not layer posteriorly. Given that the MRI sequence signals of the lesions in the ventricular system matched perfectly with the signals of the somewhat deflated SiO within the globe, these multiple ovoid lesions on imaging were most consistent with the migration of SiO from the vitreous body of the right globe into the ventricular system. This case demonstrates a diagnostic error that can occur in emergent settings because of the broad differential diagnosis for cerebral ventricular hyperdensities. A ruptured colloid cyst was considered the reason for transfer, with the anticipation of neurosurgical intervention, but further imaging demonstrated that this was an incidental finding in this patient who presented in extremis. Awareness of this rare clinical condition can prevent overutilization of resources and unnecessary interventions.
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Affiliation(s)
| | - Anthony Nguyen
- Neurosurgery, Baylor Scott & White Medical Center-Temple, Temple, USA
| | - Awais Z Vance
- Neurosurgery, Baylor Scott & White Medical Center-Temple, Temple, USA
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Khaleghi M, Wu KC, Prevedello DM. Endoscopic Supraorbital Translaminar Approach. Adv Tech Stand Neurosurg 2024; 52:171-182. [PMID: 39017794 DOI: 10.1007/978-3-031-61925-0_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
Surgical selection for third ventricle tumors demands meticulous planning, given the complex anatomic milieu. Traditional open microsurgical approaches may be limited in their access to certain tumors, prompting the exploration of alternative techniques. The endoscopic supraorbital translaminar approach (ESOTLA) has emerged as a promising alternative for managing these tumors. By combining a minimally invasive keyhole approach with endoscopic visualization, the ESOTLA provides enhanced illumination and a wider angle of view within the third ventricle. This unique advantage allows for improved access to retrochiasmatic tumors and reduces the need for frontal lobe and optic chiasm retraction required of microscopic techniques, decreasing the risk of neurocognitive and visual deficits. Complications related to the ESOTLA are rare and primarily pertain to cosmetic issues and potential compromise of the hypothalamus or optic apparatus, which can be minimized through careful subarachnoid dissection. This chapter offers a comprehensive description of the technical aspects of the ESOTLA, providing insights into its application, advantages, and potential limitations. Additionally, a case description highlights the successful surgical extirpation of an intraventricular papillary craniopharyngioma via the ESOTLA followed by targeted therapy. To better illustrate the stepwise dissection through this novel approach, a series of cadaveric and intraoperative photographs are included.
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Affiliation(s)
- Mehdi Khaleghi
- Department of Neurosurgery, The James Cancer Hospital and Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Kyle C Wu
- Department of Neurosurgery, The James Cancer Hospital and Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Daniel M Prevedello
- Department of Neurosurgery, The James Cancer Hospital and Wexner Medical Center, The Ohio State University, Columbus, OH, USA.
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3
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Korkmazer B, Arslan S, Onal EM, Ozogul M, Urganci N, Isler C, Comunoglu N, Kizilkilic O, Kocer N, Islak C. Imaging findings of intraventricular pilocytic astrocytoma. Br J Radiol 2023; 96:20220598. [PMID: 37660368 PMCID: PMC10646651 DOI: 10.1259/bjr.20220598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 06/12/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023] Open
Abstract
OBJECTIVE The aim of this study is to present the clinical and imaging findings of 16 patients with intraventricular pilocytic astrocytomas (PAs). METHODS 16 patients with histopathological diagnosis of intraventricular PA between February 2016 and January 2022 were evaluated retrospectively. Imaging and clinical findings of the patients, as well as apparent diffusion coefficient (ADC) measurements were analyzed. RESULTS Of 16 patients, 8 (%50) were male and 8 (%50) were female. The mean age of the patients was 20.8 years (2-44 years range). The most common symptoms in the patients were headache and ataxia. The mean long-axis size of lesions was found to be 48.19 ± 21.59 (range, 15-92 mm). 9 out of 16 lesions (56.2%) were located in the fourth ventricle. The majority of the lesions were iso-hypointense in T1W and hyperintense in T2W images. The mean ADC value of PAs was 1.57 × 10-3 ± 0.2 mm2/s, while the mean thalamic ADC and white matter ADC values were found to be 0.78 × 10-3 ± 0.04 and 0.76 × 10-3 ± 0.06 mm2/s, respectively. There was a statistically significant difference between the ADC values obtained from the solid components of the lesions and the thalami/white matter (p < 0.001). CONCLUSION PAs often originate from midline structures, however, they can also be located intraventricularly. Although intraventricular PAs are frequently seen in pediatric population, it should be kept in mind that they can also be seen in adults, albeit rarely. ADVANCES IN KNOWLEDGE PA should be considered in the differential diagnosis of intraventricular neoplasms in case of high ADC values.
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Affiliation(s)
- Bora Korkmazer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Serdar Arslan
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Emine Meltem Onal
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Murat Ozogul
- Department of Radiology, University of Health Sciences, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - Nil Urganci
- Department of Pathology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Cihan Isler
- Department of Neurosurgery, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Nil Comunoglu
- Department of Pathology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Osman Kizilkilic
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Naci Kocer
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Civan Islak
- Department of Radiology, Istanbul University-Cerrahpasa Cerrahpasa Medical Faculty, Istanbul, Turkey
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4
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Sharif AA, DiGiacomo E, Czarniecki M, Sayah A. Rate of Missed Intracranial Colloid Cysts on MRI and CT. Cureus 2023; 15:e49004. [PMID: 38111400 PMCID: PMC10726732 DOI: 10.7759/cureus.49004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
BACKGROUND AND PURPOSE Intracranial colloid cysts of the third ventricle are rare; however, they may be symptomatic. They can create a mass effect on the foramina of Monro, resulting in acute hydrocephalus. Colloid cysts are detectable on CT and MRI but are commonly missed. In this paper, we investigate the rate of missed colloid cysts on MRI and/or CT imaging within our multihospital metropolitan medical group. MATERIALS AND METHODS A retrospective, institutional review board-approved search of the network-wide picture archiving and communication system (PACS) from January 1, 2010, to October 31, 2020, was performed to identify reports including a "colloid cyst" in MRI brain or CT head imaging. Results without imaging and/or surgical confirmation of intracranial colloid cysts were excluded, rendering 229 cases. A PACS review of these cases was performed by two neuroradiologists to determine instances where the cyst had previously been imaged but not diagnosed on either CT or MRI. RESULTS Two hundred twenty-nine subjects had confirmed colloid cysts through imaging and/or surgical reports. Of these, 46 had prior imaging depicting a colloid cyst either on CT and/or MRI without mention on the interpretative report, resulting in a non-detection rate of 20.1%. CONCLUSION Intracranial colloid cysts can be missed at a considerably high rate, which is concerning given their clinically unpredictable nature and ability to cause significant morbidity and mortality. As such, it is important to take a proactive approach to searching for these cysts as part of a regular imaging search pattern and to continue to determine new methods of increasing detection sensitivity.
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Affiliation(s)
- Ayat A Sharif
- Neuroradiology, Georgetown University School of Medicine, Washington, USA
| | - Erik DiGiacomo
- Neuroradiology, Georgetown University School of Medicine, Washington, USA
| | - Marcin Czarniecki
- Neuroradiology, MedStar Georgetown University Hospital, Washington, USA
| | - Anousheh Sayah
- Neuroradiology, MedStar Georgetown University Hospital, Washington, USA
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5
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Kajtazi NI, Al Ghamdi J, Al Amoudi R, Zakri A, Al Shakweer W, Bafaquh M. Extensive cerebral venous thrombosis after resection of third ventricle colloid cyst. Surg Neurol Int 2023; 14:201. [PMID: 37404486 PMCID: PMC10316143 DOI: 10.25259/sni_348_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/27/2023] [Indexed: 07/06/2023] Open
Abstract
Background The third ventricle colloid cyst (CC) is a benign growth usually located in the third ventricle and can cause various neurological symptoms, including sudden death. Modern surgical interventions may still result in a wide range of complications and cerebral venous thrombosis (CVT) is among them. Case Description A 38-year-old female with an existing diagnosis of diabetes mellitus (DM) and hypothyroidism and a 6-month history of headaches, blurred vision, and vomiting presented to our clinic 3 days after the headaches became excessively severe. Neurological examination on admission revealed bilateral papilledema without any associated focal neurological deficits. Brain computed tomography and magnetic resonance imaging confirmed the presence of a third ventricle CC and associated non-communicating hydrocephalus involving the lateral ventricles. As a result, the patient underwent emergency bilateral external ventricular drainage (EVD) insertion followed by a third ventricular CC excision under neuronavigation through a right frontal craniotomy. Twelve days postoperatively, the patient developed further headaches followed by a generalized tonic-clonic seizure that led to no postictal neurological deficits. Nonetheless, computed tomography venography of the brain revealed extensive thrombosis of the superior sagittal sinus, inferior sagittal sinus, right sigmoid sinus, and right internal jugular vein. A newly diagnosed CVT was treated with intravenous heparin. The patient was discharged with warfarin, which was discontinued after 12 months. Ten years after her illness, she remained stable and free from any neurological deficits but still suffered from chronic mild headaches. Conclusion A preoperative venous study should be performed in all cases to gain a better understanding of the venous anatomy. We advocate meticulous microsurgical techniques to protect the venous system surrounding the foramen of Monro and reduce the amount of retraction during surgery.
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Affiliation(s)
- Naim Izet Kajtazi
- Department of Neurology, National Neurosciences Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Juman Al Ghamdi
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Al Amoudi
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Amna Zakri
- Department of Intervention Neuroradiology, Medical Imaging Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Wafa Al Shakweer
- Department of Clinical Laboratory Administration, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Bafaquh
- Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
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Melicher D, Gaál S, Berényi T, Fenyves BG, Novák PK, Tóth A, Szegedi L, Varga C. Acute hydrocephalus caused by a colloid cyst - a case report. Int J Emerg Med 2023; 16:28. [PMID: 37076791 PMCID: PMC10114300 DOI: 10.1186/s12245-023-00500-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/02/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Colloid cysts are rare benign, slowly growing intracranial tumors of endodermal origin. Most colloid cysts are found incidentally and are asymptomatic, but rarely, they can lead to sudden death. CASE PRESENTATION A 73-year-old female patient was admitted to our emergency department with complaints of dizziness, nausea, vomiting, fatigue, walking difficulties, and behavioral changes. CT imaging revealed acute obstructive hydrocephalus attributable to a third ventricular colloid cyst. The patient was immediately transferred to a tertiary center where she underwent successful neurosurgical resection of the mass. Pathology results of the lesion confirmed the diagnosis of colloid cyst. CONCLUSION The case we present emphasizes the critical importance of prompt identification of warning signs, complex thinking, and evaluation. Establishing the right diagnostic approach early on can facilitate accurate diagnosis.
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Affiliation(s)
- Dóra Melicher
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary.
| | - Szabolcs Gaál
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Tamás Berényi
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
| | - Bánk Gábor Fenyves
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
- Department of Molecular Biology, Semmelweis University, Budapest, Hungary
| | - Pál Kaposi Novák
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Ambrus Tóth
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - László Szegedi
- National Institute of Clinical Neurosciences, Budapest, Hungary
| | - Csaba Varga
- Department of Emergency Medicine, Semmelweis University, Budapest, Hungary
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7
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Muroya Y, Suzuki K, Nagasaka S, Nakano Y, Yamamoto J. Primary central nervous system lymphoma of the third ventricle with intra-tumoral hemorrhage: A case report and literature review. Oncol Lett 2022; 25:47. [PMID: 36644156 PMCID: PMC9811644 DOI: 10.3892/ol.2022.13633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/02/2022] [Indexed: 12/16/2022] Open
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare brain tumor that most commonly arises in the cerebral white matter, basal ganglia, peri-ventricle or corpus callosum. Confinement of PCNSL to the third ventricle is extremely rare, and seldom presents with intratumoral hemorrhage (ITH). The present study described the case of a 75-year-old woman who presented with obstructive hydrocephalus due to third-ventricle PCNSL. On magnetic resonance imaging (MRI), the tumor presented ITH on T2*-weighted images and a highly elevated regional cerebral blood volume on dynamic susceptibility contrast-enhanced MRI (DSC-MRI). Due to the high elevation of the regional cerebral blood volume, high-grade glioma was suspected as a preoperative diagnosis. The patient underwent endoscopic tumor biopsy and third ventricle PCNSL was successfully diagnosed. The patient achieved good prognosis at an early stage after the start of treatment initiation. There are many differential considerations for a third-ventricle tumor, and DSC-MRI can help the differential diagnosis of these tumors. Furthermore, the presence of ITH can lead to the inaccurate estimation of regional cerebral blood volume values. Overall, silent or microhemorrhage in PCNSL may be underestimated, and clinicians should therefore carefully evaluate tumor vascularity by MRI.
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Affiliation(s)
- Yu Muroya
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Kohei Suzuki
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan,Correspondence to: Dr Kohei Suzuki, Department of Neurosurgery, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi-ku, Kitakyushu, Fukuoka 807-8555, Japan, E-mail:
| | - Shohei Nagasaka
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Yoshiteru Nakano
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
| | - Junkoh Yamamoto
- Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan
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8
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Dodson CA, Goodloe JM. Headache and weakness in a young adult female. J Am Coll Emerg Physicians Open 2022; 3:e12772. [PMID: 35782347 PMCID: PMC9244344 DOI: 10.1002/emp2.12772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/09/2022] [Accepted: 06/01/2022] [Indexed: 11/07/2022] Open
Affiliation(s)
- Chance A. Dodson
- Department of Emergency MedicineUniversity of Oklahoma School of Community MedicineTulsaOklahomaUSA
| | - Jeffrey M. Goodloe
- Department of Emergency MedicineUniversity of Oklahoma School of Community MedicineTulsaOklahomaUSA
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9
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Zoli M, Guaraldi F, Zenesini C, Acciarri N, Sollini G, Asioli S, Faustini-Fustini M, Agati R, Cirillo L, Tonon C, Lodi R, Pasquini E, Mazzatenta D. Role of endoscopic endonasal approach for craniopharyngiomas extending into the third ventricle in adults. BRAIN & SPINE 2022; 2:100910. [PMID: 36248121 PMCID: PMC9560538 DOI: 10.1016/j.bas.2022.100910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 05/21/2022] [Accepted: 06/25/2022] [Indexed: 06/16/2023]
Abstract
•EAA is an innovative, promising, safe and effective approach for 3VCPs.•Key of success is surgeon learning curve in endoscopy and patients selection.•With correct indications, EEA gives GTR and morbidity rate similar to other routes.•Clinical, tumoral and anatomical features should be considered for EEA selection.
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Affiliation(s)
- Matteo Zoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Federica Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Corrado Zenesini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Epidemiology and Statistics Unit, Bologna, Italy
| | - Nicola Acciarri
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Giacomo Sollini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Sofia Asioli
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- Azienda USL di Bologna, Anatomic Pathology Unit, Bellaria Hospital, Bologna, Italy
| | - Marco Faustini-Fustini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
| | - Raffaele Agati
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroradiologia con Tecniche ad Elevata Complessità, Bologna, Italy
| | - Luigi Cirillo
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC di Neuroradiologia, Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Caterina Tonon
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neuroimmagini Funzionali e Molecolari, Bologna, Italy
| | - Raffaele Lodi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Ernesto Pasquini
- Azienda USL di Bologna, ENT Department, Bellaria Hospital, Bologna, Italy
| | - Diego Mazzatenta
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi - Pituitary Unit, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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10
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Alshuaylan RN, Alismail AA, Haobani FM, Alfulayw MR, Abu Maghayed AY, Khashoggi AA, Al-Mahdi SA, AlKishi SA, Alnaqaa JH, Alwazzan SB, Alshammari M. Colloid Cyst: A Potentially Life-Threatening Etiology of Severe Headache in a Patient With Migraine. Cureus 2021; 13:e18424. [PMID: 34733596 PMCID: PMC8557790 DOI: 10.7759/cureus.18424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2021] [Indexed: 12/03/2022] Open
Abstract
Headache is a common cause of emergency department (ED) visits. Migraine is a prevalent neurological disorder that is encountered by emergency physicians in day-to-day practice. However, patients with a known history of migraines should be carefully evaluated when presenting with headaches and serious pathologies of headache should be ruled out. We report the case of a 43-year-old woman, with a known history of classic migraine, who presented to the ED with a severe headache. She described the headache as persistent generalized pain. The headache was worse on awakening and bending. The headache did not improve with the use of oral sumatriptan. She reported that the current episode of headache is more severe than her usual migraine headaches. The patient underwent a cranial CT scan which demonstrated a homogenously hyperdense well-defined round lesion located in the midline at the approximate location of the foramen of Monro with prominent lateral ventricles, conferring the diagnosis of the colloid cyst. The patient underwent a right craniotomy with resection of the cyst using the transcallosal approach. Recognition of this important diagnosis is crucial to prevent serious neurological complications by having timely management.
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Affiliation(s)
| | | | | | | | | | - Alya A Khashoggi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Jawad H Alnaqaa
- General Surgery, Al Kharj Military Industries Corporation Hospital, Al-Kharj, SAU
| | - Shahad B Alwazzan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Malak Alshammari
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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11
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Hung ND, Ngan VK, Duc NM. Intrinsic Third Ventricular Papillary Craniopharyngioma: A Report of Five Cases and Literature Review. Int Med Case Rep J 2021; 14:83-87. [PMID: 33623444 PMCID: PMC7894859 DOI: 10.2147/imcrj.s295848] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/03/2021] [Indexed: 02/05/2023] Open
Abstract
Background Craniopharyngiomas are common lesions that occur in the suprasellar region; however, strictly intrinsic third ventricular craniopharyngiomas are rare. Case Series We aimed to describe the magnetic resonance imaging features observed in five cases of strictly intrinsic third ventricular papillary craniopharyngiomas, including two cases of mixed cystic and solid tumors and three cases of pure solid masses. Conclusion Among the adult population, intrinsic third ventricular papillary craniopharyngiomas should be considered when either solid or mixed cystic and solid masses are observed, in which the solid component shows heterogeneous intensity, heterogeneous and strong enhancement, and is strictly located in the third ventricle.
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Affiliation(s)
- Nguyen Duy Hung
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam.,Department of Radiology, Viet Duc Hospital, Hanoi, Vietnam
| | - Vuong Kim Ngan
- Department of Radiology, Vinmec Times City International Hospital, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam.,Department of Radiology, Children's Hospital 2, Ho Chi Minh City, Vietnam
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12
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Abstract
Pilocytic astrocytomas are tumors of the central nervous system mostly during the first two decades of life. Although they are mostly common in the midline structures of children, pilocytic astrocytoma within the ventricular system of an adult is extremely rare. We report a case of a 38-year old woman with obstructive hydrocephalus secondary to a brain tumor within the third ventricle. On histological examination, the tumor exhibited biphasic growth pattern comprising compacted cellular areas with Rosenthal fibers and loose textured microcystic areas with eosinophilic granular bodies. Mitosis or necrosis was not present. Immunohistochemical studies demonstrated glial fibrillary acid protein (GFAP), Olig2, and ATRX positivity as well as NeuN and EMA negativity. Ki67 labeling index was less than 1%. Molecular studies revealed that there are no isocitrate dehydrogenase (IDH) gene mutation and H3F3A mutation. This clinical presentation along with the histologic and molecular findings is consistent with a pilocytic astrocytoma arising in the third ventricle of this adult brain, which indicates that pilocytic astrocytoma can present as an intraventricular tumor in an adult patient and should be routinely included in the differential diagnosis of intraventricular brain neoplasm.
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Affiliation(s)
| | - Zhenggang Xiong
- Address correspondence to:Zhenggang Xiong, Division of Neuropathology, Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical School and University Hospital, Rutgers University, 125 Paterson Street, MEB 231, New Brunswick, NJ 08903, USA. E-mail:
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13
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Demir MK, Yapıcıer O, Karakaya OF, Mert B, Seker A. A primary third ventricle mixed germ cell tumor with leptomeningeal dissemination of immature teratoma component. Childs Nerv Syst 2020; 36:629-633. [PMID: 31418081 DOI: 10.1007/s00381-019-04351-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/09/2019] [Indexed: 12/17/2022]
Abstract
A 17-year-old male patient presented to the clinic with a headache, nausea, and vomiting. Magnetic resonance imaging demonstrated a fat-containing and -enhancing heterogeneous tumor in the third ventricle, and fat droplets within the ventricles and the subarachnoid space. Obstructive hydrocephalus was also present. Emergency subtotal removal of the mass was performed via interhemispheric transcallosal approach. The histopathological diagnosis was a mixed germ cell tumor that was composed of embryonal carcinoma, yolk-sac tumor, germinoma, and immature teratoma containing a large amount of mature elements. The patient was referred for postoperative chemoradiotherapy. A mixed germ cell tumor is a rare type of nongerminomatous germ cell tumor that is made up of at least two different types of germ cell tumors. These may include germinoma, choriocarcinoma, embryonal carcinoma, yolk sac tumor, mature teratoma, immature teratoma, or teratoma with malignant degeneration. As far as we know, this is the first reported case of a primary third ventricle mixed germ cell tumor with leptomeningeal dissemination of the immature teratoma component that contains grossly visible mature elements at admission.
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Affiliation(s)
- Mustafa Kemal Demir
- Department of Radiology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey.
| | - Ozlem Yapıcıer
- Department of Pathology, Bahçeşehir University School of Medicine, Göztepe Medical Park Training and Education Hospital, Istanbul, Turkey
| | | | - Başak Mert
- Bahçeşehir University School of Medicine, Istanbul, Turkey
| | - Askın Seker
- Department of Neurosurgery, Altınbas University Faculty of Medicine, Bahçelievler Medical Park Hospital, Istanbul, Turkey
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