Pilocytic astrocytoma - third ventricle
Previous history of seizures one year ago leading to the diagnosis of a brain tumor. The lesion was treated with surgical resection associated with chemotherapy and radiotherapy. New exam for follow-up.
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There is a suprasellar heterogeneous mass enlarging and obstructing the third ventricle, compressing the mesencephalon and the cerebral peduncles, and displacing without invading the basilar artery and the circle of Willis' vessels. It shows a high T2 signal that suppresses partially on FLAIR, no calcifications or acute hemorrhage are seen. The lesion obstructs the interventricular foramina and the proximal cerebral aqueduct promoting a chronic obstructive hydrocephalus.
This is a histologically proven pilocytic astrocytoma, which is a low-grade and slow growing tumor being the most common primary brain tumor in children. The majority tend to occur in the cerebellum or optic nerve/chiasm, and the third ventricle region, as in this case, is the third frequent location.
Unfortunately, this case does not have post-contrast sequences, which was supposed to shown enhancement.
Despite the low aggressivity of the tumor, at this location the tumor is only palliative managed. A long-standing severe hydrocephalus is also present.