Lymphoplasmacyte-Rich Meningioma of the Third Ventricle: Case Report

Introduction Meningiomas are the most common primary intracranial tumors, accounting for up to 35% of the neoplasms in this category. Approximately 10­20% of these neoplasms are histologically atypical, and the lymphoplasmacyte-rich meningioma (LPM) corresponds to a very rare subtype of meningioma that is characterized histopathologically by massive infiltrates of inflammatory cells. The case described in the present study is the sixth case of an intraventricular LPM found in the literature and the first case considering the location in the third ventricle. Case Description A 21-year-old male without previous comorbidities sought medical attention due to visual impairment (complaining of intermittent visual blur) for 2 months. A magnetic resonance imaging of the brain confirmed the presence of a well-delimited solid mass in the third ventricle of 3.0 2.3 cmwith a cystic component that extended itself inferiorly and distorted the visual pathway anatomy. Neurosurgeons decided to access the lesion using an interhemispheric transcallosal approach with a transforaminal access, and the lesion was resected completely. The patient has an ambulatorial endocrinological follow-up and is neurologically stable 6 months after the procedure. No new visual deficits were noted. Conclusion Lymphoplasmacyte-rich meningioma is a very rare intracranial tumor, and the involvement of the third ventricle make this case unique.

Suprasellar chordoid glioma: a report of two cases

SUMMARY Chordoid glioma (CG) is considered a slow growing glial neoplasm. We report two new cases with endocrinological presentation, management and outcome. Case reports: 1) An 18 year-old female patient was admitted due to headaches, nausea and vomiting and visual abnormalities. She was in amenorrhea. A brain magnetic resonance imaging (MRI) demonstrated a 35 mm-diameter sellar and suprasellar mass. An emergency ventricular peritoneal valve was placed due to obstructive hydrocephalus. Transcraneal surgery was performed. The patient developed central hypothyroidism, adrenal insufficiency and transient diabetes insipidus; she never recovered spontaneous menstrual cycles. Histopathologic study showed cells in cords, inside a mucinous stroma, positive for glial fibrillary acidic protein (GFAP). Due to residual tumor gamma knife radiosurgery was performed. Three years after surgery, the patient is lucid, with hypopituitarism under replacement. 2) A 46 year-old woman complained about a three year-history of amenorrhea, galactorrhea and headache. An MRI showed a solid-cystic sellar mass 40 mm-diameter that extended to the suprasellar cistern. She had hypogonatropic hypogonadism and mild hyperprolactinemia. The tumor mass was removed via nasal endoscopic approach. Histopathological study reported cellular proliferation of glial lineage positive for GFAP. The patient evolved with central hypothyroidism and diabetes insipidus. She was re-operated for fistula and again under the diagnosis of extradural abscess. She evolved with cardiorespiratory descompensation and death, suspected to be due to a thromboembolism. In conclusion, the first case confirms that best treatment for CG is surgery considering radiotherapy as an adjuvant therapy. The other case, on the contrary, illustrates the potentially fatal evolution due to surgical complications.

Tratamiento endoscópico de quistes coloideos del tercer ventrículo / Third ventricle colloid cysts endoscopic approach

Introducción: los quistes coloideos (QC) son tumores benignos de crecimiento lento, que comprenden menos del 1% de los tumores intracraneales. Se presentan en adultos jóvenes y se ubican más frecuentemente en el techo del tercer ventrículo. El objetivo de este trabajo es presentar una serie de pacientes con QC del tercer ventrículo operados por vía endoscópica, analizar la técnica quirúrgica, ventajas y desventajas. Desarrollo: se realizó una búsqueda retrospectiva de pacientes operados por vía endoscópica, en el Servicio de Neurocirugía del Hospital Italiano de Buenos Aires, de tumores del tercer ventrículo en un período de 2 años (2013-2015), con diagnóstico de QC confirmado por anatomía patológica . Se identificaron cinco pacientes, tres mujeres y dos hombres, cuyo promedio de edad fue de 50 años. No hubo complicaciones perioperatorias y ninguno mostró recidiva en el lapso de observación. Conclusión: la vía endoscópica es una vía técnicamente simple y con muy baja morbilidad. Si bien no siempre puede realizarse una exéresis completa, los trabajos prospectivos permitirán definir si esto resulta suficiente para el control de la enfermedad. (AU)

Colloid cysts are benign, slow-growing tumors, comprising less than 1% of intracranial tumors. They occur in young adults and are more frequently located on the roof of the third ventricle. The objective of this study is to present a series of patients with Colloid cysts operated endoscopically and analyze advantages and disadvantages of this surgical technique. We performed a retrospective review of Colloid Cysts operated on endoscopically, at the Neurosurgical Department of Hospital Italiano de Buenos Aires in a period of 2 years (2013-2015). Five patients were identified, three women and two men whose average age was 50 years. No perioperative complications were observed, with no recurrences during the follow up period. Conclusion: the endoscopic approach is technically simple and has very low morbidity. Although a complete excision can not always be performed, prospective studies will allow us to define whether if is sufficient to control the disease. (AU)

Chordoid Glioma with Intraventricular Dissemination: A Case Report with Perfusion MR Imaging Features

Chordoid glioma is a rare low grade tumor typically located in the third ventricle. Although a chordoid glioma can arise from ventricle with tumor cells having features of ependymal differentiation, intraventricular dissemination has not been reported. Here we report a case of a patient with third ventricular chordoid glioma and intraventricular dissemination in the lateral and fourth ventricles. We described the perfusion MR imaging features of our case different from a previous report.

Glioma cordoide do terceiro ventrículo: descrição de um novo caso / Chordoid glioma of the third ventricle: a new case report

O glioma cordoide é um tumor cerebral raro, recentemente descrito, localizado na região do terceiro ventrículo e com características histológicas, imuno-histoquímicas e ultraestruturais peculiares. Este estudo ilustra um caso de glioma cordoide do terceiro ventrículo em uma paciente de 59 anos de idade.

Chordoid glioma is a recently described and rare brain tumor located in the third ventricular region, with distinctive histological, immunohistochemical and ultrastructural features. The present report describes a case of chordoid glioma of the third ventricle in a 59-year-old female patient.

Colloid cyst of the third ventricle; endoscopic excision

Cerebrospinal fluid shunting or microsurgical resection of the colloid cysts of the third ventricle have long been a standard treatment. The emergence of neuroendoscopy has lead to its application in various neurosurgical problems. Colloid cyst of the third ventricle is one such pathology where endoscopic treatment has been performed with great clinical success during the past decade. We now Although considered less efficacious than microsurgical excision endoscopic excision is less invasive and much simpler. [1] to assess the extent of excision [2] to assess the morbid anatomy of the colloid cyst [3] to assess the risk of complications [4] to assess the functional outcome. Eight years [Jul 2001-June 2009]. Endoscopic resections of 15 colloid cysts of the third ventricle with obstruction of Foramina of Monroe in all cases. Total removal was achieved in 10 [66.7%] cases. In 5 [33.3%] patients the colloid material was evacuated completely while the remnant of the capsule adherent to its origin was left behind. Two [13.3%] patients developed meningitis one week postoperatively and one died subsequently. Nine [60%] patients had excellent recovery as the symptoms were relieved during a period of 3 to 24 months. Five [33.3%] of the total patients required ventriculoperitoneal shunt for obstructive hydrocephalus which developed with in 2 weeks after surgery. One out of the total number of patients deteriorated postoperatively on the existing neurological deficit. There has not been any recurrence until now with subtotal excision of the capsule. Keyhole surgery under endoscopic visual control offers an alternative, very effective minimally invasive approach for the excision of colloid cyst of the third ventricle and is likely to replace microsurgical resection as a standard procedure

Colloid cyst of brain

Colloid cysts are benign congenital cysts that arise in the anterior part of the third ventricle of brain at the level of foramen of Monro and constitute 1% of all cerebral tumors. They occur usually in the younger age and are asymptomatic unless they compress foramen of Monro and cause hydrocephalus. They can be symptomatic and fatal, if not treated properly. A case is reported here who had an outside referral for CT Scan of brain with main complaints of persistent recurrent headache and positional vertigo

Fever is associated with third ventricular shift after intracerebral hemorrhage: pathophysiologic implications.

BACKGROUND: Studies have shown the detrimental effect of increased temperature on brain injury. Fever is common after intracerebral hemorrhage (ICH). The term 'central fever' is often used when no cause is identified. AIM: The aim of the study was to determine the correlation of fever with third ventricular shift in 61 patients with ICH and hypothesize about the mechanism of fever. SETTING: Neurointensive Care Unit. DESIGN: Prospective observational study. MATERIALS AND METHODS: From August 1999 to April 2000, data from 61 patients with ICH were prospectively collected including maximum temperature (Tmax) and fever (T> 37.5 degrees C) at 24, 48, 72 and 96 hours, ICH volume, and third ventricular shift. Outcome measures included discharge mortality, 3-month National Institute of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index (BI). STATISTICAL ANALYSIS: Spearman correlation coefficient, Mann-Whitney test, and logistic regression were used to assess relationships. RESULTS: Fifty-six per cent of patients had fever in the first 24 hours and 53% for at least two consecutive days. There was a correlation between ICH volume and Tmax at 24 hours (P =0.04) and 72 hours (P =0.03) and fever at 24 hours (P =0.039) and 72 hours (P =0.036). Tmax at 72 hours correlated with third ventricular shift (P =0.01). Those with shift were more likely to have fever within the first 72 hours (P =0.049) and worse outcome. Fever at 72 hours was associated with a higher discharge mortality (P =0.046) and trend of a worse 3-month NIHSS score (P =0.06). CONCLUSION: Fever is common after ICH and correlates with ICH volume and third ventricular shift suggesting a role of hypothalamic compression in "central fever." There was a trend towards a worse outcome with fever.

Colloid cyst of the third ventricle

The colloid cyst of the 3rd ventricle is a rare tumor [1% of the intracranial tumors]. It is a benign tumor of the young adult. The definite diagnosis is radiologic particularly. The curative treatment is above all surgical. We report 3 cases of colloid cyst explored by computerized tomography [3 cases]. The mean age of the patients is 22.5 years old [6-35 years old], with a sex-ratio equal to 2. The signs of intracranial high blood pressure have been the mode of discovery in the 3 cases. The definite diagnosis has been based on the cerebral computerized tomography, realized in the 3 cases before and after injection by iodized contrast product with axial slices in 3 cases and coronal axial slices in 2 cases. It visualized round and well limited mass localized in the anterosuperior part of the 3rd ventricle that measured respectively 1.1; 1.5 and 2.5 cm. This mass is spontaneously hyperdense [about 60 UH], not modified after the injection of the contrast product. It is the cause of biventricular hydrocephalus in the 3 cases. The palliative treatment consisted in a ventriclo-peritoneal derivation in the 3 patients. Any patient underwent the cyst ablation. They are still coming for medical advice. The colloid cyst of the 3rd ventricle is a pathology that benefitted from the imaging progresses particularly the computerized tomography and the imaging by magnetic reasonance. Indeed, the radiology permits not only to arrive at the definite diagnosis of the colloid cyst, but also to orientate the therapeutic procedure when it is about stereotaxic aspiration

Meningioma do terceiro ventrículo na infância: relato de caso / Third ventricle meningioma in a child: case report

OBJETIVO: Meningiomas intraventriculares sao lesoes raras, mais ainda as que acometem o terceiro ventrículo. Na infância, somente 16 casos foram relatados na literatura. Acrescentamos este relato de meningioma da parte anterior do terceiro ventrículo em uma menina, juntamente com breve revisao da literatura. APRESENTAÇAO E INTERVENÇAO: Criança previamente hígida, de 5 anos, foi internada com história de vômitos e cefaléa de 2 meses de duraçao. Ao exame clínico e neurológico, foi notado somente papiledema. Foi realizada tomografia computadorizada de crânio, que mostrou volumosa lesao na linha média supratentorial, ocupando toda a regiao do terceiro ventrículo, captante, com dilataçao ventricular suprajacente. A paciente foi submetida a craniotomia frontal direita, e a lesao totalmente removida através da via transcalosa interfornical. O pós-operatório foi sem intercorrências, e nao foi necessária derivaçao ventricular permanente. Hoje, dois anos e meio após a alta, a criança está em acompanhamento ambulatorial, sem déficits neurológicos, com bom desempenho escolar e sem evidência de recidiva nas tomografias de controle. CONCLUSAO: Meningiomas da parte anterior do terceiro ventrículo sao lesoes raras na infância. O tratamento cirúrgico dos meningiomas intraventriculares no passado era associado a altas taxas de morbidade e mortalidade. Com o advento das modernas técnicas neuroanestésicas e neurocirúgicas, e do suporte intensivo pós-operatório, atualmente estas lesoes podem ser removidas na sua totalidade, com morbidade e mortalidade praticamente nulas

Acesso endoscópico transepto-interforniceal para cistos colóides: relato de caso / Endoscopic transepto-interforniceal approach to colloid cysts: case report

A abordagem endoscópica de cistos colóides ainda é matéria controversa. As opçoes de tratamento sao variadas: observaçao com exames seriados, tratamento da hidrocefalia, aspiraçao por estereotaxia, microcirurgia e endoscopia. O autor relata o caso de um paciente com cisto colóide do terceiro ventrículo, localizado em posiçao retroforaminal, no teto diencefálico, dissecando os dois fornices projetando-se supero-posteriormente em direçao ao assoalho do ventrículo lateral, por dentro do cavum do septo pelúcido. A lesao foi alcançada com neuroendoscópio rígido, através de um orifício de trépano pré-coronal situado a 2,5 cm da linha média (ponto de Kocher). Seguindo por via transventricular, a lâmina direita do septo pelúcido foi aberta, posterior à veia septal. A lesao, muito endurecida, situada entre os dois fórnices, foi parcialmente ressecada através da via endoscópica transventricular transepto-interforniceal. Realizamos também septostomia e terceiro ventriculostomia endoscópicas neste paciente. Os diferentes tipos de procedimentos cirúrgicos das patologias situadas no terceiro ventrículo sao discutidos com ênfase no papel da endoscopia