Presentation
Severe headache.
Patient Data
Midline anterior third ventricular mass lesion, anteriorly bulging through the anterior third ventricular recesses (supra-optic and infundibular), posteriorly abutting the anterior surface of the inter-thalamic adhesions, anterosuperior abutting the lamina terminalis and anterior commissure, and inferiorly bulging through the third ventricular floor exerting mass effect on the hypothalamic region and optic chiasm. Mass effect on the infundibular stalk is also noted.
The inferior portion of the lesion is seen abutting the distal basilar artery at its bifurcation as well as the proximal P1 segments of the posterior cerebral arteries. The anterior lesion portion is closely related to the ACOM and A1 segments of the ACAs. The lesion is seen in close relation to the midline deep cerebral veins
The lesion is seen obliterating the third ventricular lumen, with subsequent moderate to marked hydrocephalus involves the lateral ventricles with associated periventricular interstitial edema and effaced CSF spaces
No sellar or supraselalr cistern involvement.
It elicits inhomogeneous intermediate signal in T1, high signal in T2 and flair, no diffusion restriction and avid inhomogeneous enhancement in the post contrast T1.
The CT showed no calcifications.
The histopathology revealed adamantinomatous craniopharyngioma, WHO grade 1.
Case Discussion
This is a case of pathologically proven adamantinomatous craniopharyngioma in a very unusual location involving the third ventricle, with no sellar or suprasellar involvement. Few cases were reported in the literature 1,2.
The top radiological DD is chordoid glioma. other DDs include; germinoma, ependymoma, intraventricular meningioma, choroid plexus papilloma, and metastasis.
Unable to process the form. Check for errors and try again.