Intrapontomesencephalic colloid cyst: an unusual location. Case report

Diagnostic Methods in Forensic Pathology: Autoptic Findings and Immunohistochemical Study in Cases of Sudden Death Due to a Colloid Cyst of the Third Ventricle

The colloid cyst is a non-malignant tumor growth made of a gelatinous material covered by a membrane of epithelial tissue. It is usually located posterior to the foramen of Monro, in the anterior aspect of the third ventricle of the brain. Due to its location, it can cause obstructive hydrocephalus, increased intracranial pressure, and sudden cardiac death, catecholamine-mediated, through hypothalamus compression. All the mechanisms are still controversial, but the role of catecholamine has been confirmed with histological findings that highlighted myocardial injury (coagulative myocytolysis and contraction band necrosis, CBN). This study presents a case of sudden death in a previously healthy 22-year-old male due to a colloid cyst of the third ventricle. A complete autopsy was performed, highlighting in the brain an abundant quantity of cerebrospinal fluid (CSF) and a 2 cm pale grayish-green rounded cyst formation partially filling and distending the third ventricle. The diagnosis was confirmed through immunohistochemical investigation: positivity for Periodic acid-Schiff (PAS) staining and CK7 expression. In cases such as the one reported here, a combined approach of autopsy, histology, and immunohistochemistry is mandatory in order to identify the neoformation's location and morpho-structural characteristics for a correct differential diagnosis, as well as to identify the cause of death.

Hemorrhagic cavum vergae colloid cyst: A presentation of anterograde amnesia without hydrocephalus

Background:

Colloid cysts characteristically arise from the roof of the third ventricle near the foramen of Monro, causing symptoms from obstructive hydrocephalus. However, atypical locations have been reported with various clinical presentations, growth patterns, and displacement of surrounding anatomic structures.

Case Description:

Here, we describe the interesting case of a patient with a large hemorrhagic cavum vergae colloid cyst presenting with anterograde amnesia soon after starting antiplatelet therapy. The patient did not have hydrocephalus on presentation and his amnesia persisted after complete removal of the hemorrhagic mass through transcallosal interforniceal approach.

Conclusion:

To the best of our knowledge, this is the only reported instance of a colloid cyst presenting with amnesia in the absence of hydrocephalus. Pathophysiology as well as diagnostic and management strategies of hemorrhagic colloid cysts are discussed.

[Brainstem arachnoid cyst: case report and review]

There are no literature data on brainstem arachnoid cysts in humans.

OBJECTIVE

To describe the clinical case of brainstem (pontomesencephalic) arachnoid cyst and to analyze classification, pathogenesis, differential diagnosis and treatment of this pathology considering literature data and own experience.

MATERIAL AND METHODS

A 29-year-old patient with pontomesencephalic arachnoid cyst is reported. The disease manifested in childhood with a headache aggravated by bending and pushing. Later, syncope, vegetative-visceral paroxysms, mild oculomotor disturbances, transient paresthesia and numbness of the left half of the face occurred. Headaches became significantly more severe and resulted nausea and vomiting. Magnetic resonance imaging (MRI) revealed a two-chambered arachnoid cyst. A smaller chamber was localized in interpeduncular cistern, a larger one - in brainstem.

RESULTS AND DISCUSSION

Differential diagnosis included cystic glioma and Virchow-Robin space enlargement. Fenestration of the cyst wall within interpeduncular cistern was performed via right-sided pterional approach. The diagnosis was verified by histological examination. The follow-up period was 14 months. We observed postoperative cyst reduction confirmed by MR data and regression of all symptoms except for minimal signs of medial longitudinal fasciculus dysfunction.

CONCLUSION

Correct surgical approach for brainstem arachnoid cyst complicated by progressive neurological deterioration is confirmed by postoperative regression of cyst and symptoms.

[Changes in treatment paradigm for neurosurgical patients in the era of stereotactic irradiation. By the 15th anniversary of the Neuroradiosurgery in Russia]

INTRODUCTION

Stereotactic method and new irradiation techniques ensured radiosurgical treatment with high precision and conformity and significantly expanded the indications for stereotactic irradiation in neurosurgery.

MATERIAL AND METHODS

Over 15-year period, 29 976 patients underwent irradiation in various modes of fractionation on linear accelerators and Gamma Knife system at the first national radiosurgery center.

RESULTS

Stereotactic radiotherapy and radiosurgery are followed by minimal number of complications and side reactions. At the same time, 5-year control of tumor growth for skull base meningioma was 96.8%, neuroma - 97%, glomus tumor - 94%, pituitary adenoma - 96-98%, craniopharyngioma - 95% in overall 10-year survival 86%, pilocytic astrocytoma - 97.5% in overall 5-year survival 99%. In intracranial metastases, median overall survival after radiosurgery was 10.1 months, 24- and 36-month overall survival - 25.9% and 19.2%, respectively. In patients with recurrent high-grade glioma, overall survival was 27.4 months. In case of metastatic spine lesions, control of tumor growth within 1 year was achieved in 90% of patients, pain relief - in more than 50% of cases. Obliteration of AVM and dural fistula was found in more than 80% of patients in years after treatment. Reduction or disappearance of pain was also observed in 80% of patients with trigeminal neuralgia.

CONCLUSION

Stereotactic irradiation is effective and safe in patients with various pathologies of the central nervous system and characterized by high socio-economic indicators. Our own data indicate more significant role of stereotactic irradiation in the treatment of neurosurgical patients and make it possible to revise the existing treatment standards.

Transtemporal-transchoroidal approach and its transamygdala extension to the posterior chiasmatic cistern and diencephalo-mesencephalic lesions

The aim of this report is to illustrate the successful surgical management of five patients with suprasellar retrochiasmatic and diencephalo-mesencephalic tumours, using a trans-amygdala extension of the trans-temporal/trans-choroidal fissure approach. The procedure is described for five surgically treated patients with such lesions that includes three retrochiasmatic craniopharyngiomas, one hypothalamic hamartoma, and one pilocytic astrocytoma in the left crus cerebri. The management procedure included computed tomography scan (CT scan) and magnetic resonance imaging (MRI). The trans-temporal/trans-choroidal fissure approach enabled us to perform total tumour resection in four patients and a subtotal resection in one. Some technical aspects and pitfalls of the procedure are discussed. This method creates optimum conditions for a radical excision of various suprasellar retrochiasmatic and diencephalo-mesencephalic tumours without mortality and only minimum morbidity. However, no single surgical approach can provide access to the entire variety of tumours located in the suprasellar retrochiasmatic and diencephalo-mesencepalic region. Surgical approaches must be tailored to the site, type of lesion, and its extensions. This method is only another surgical option. Its successful use requires a familiarity with the anatomy of these regions and an understanding of its specificity for a radical excision of some selected tumours, as well as its limitations to access others types of lesions. Although, it seems effective, this approach needs to be evaluated by further experience, owing to the small number of patients reported in this series.

Neuro-endoscopic management of mesencephalic intraparenchymal cyst: a case report

BACKGROUND

Intraparenchymal cyst of the mesencephalon is rare, and its natural course is unclear. The optimal treatment for this entity is still undetermined.

CASE DESCRIPTION

A 54-year-old woman was found to have asymptomatic multilobulated mesencephalic cysts. Two years after the initial diagnosis, she experienced headache and double vision, when MRI showed the enlargement of the multilobulated cystic lesions which markedly compressed the mesencephalon and the aqueduct, resulting in noncommunicating hydrocephalus. She underwent diagnostic endoscopic biopsy and ETV by flexible endoscopic system, which revealed the mesensephalic cyst wall at the dorsal part of the third ventricle floor. A part of the cyst membrane was carefully excised by endoscopic forceps without injuring the surrounding structures. Histopathological examination revealed that the cyst wall was exclusively neuroglial tissue, and the presence of neoplasm was ruled out. Her symptoms were relieved immediately after surgery, and postoperative MRI showed both the shrinkage of mesencephalic cysts and the improvement of hydrocephalus. There is no recurrence of her symptoms, and MRI findings have been stable during the 3 year follow-up period.

CONCLUSION

Intraparenchymal cysts of the mesencephalon have an expanding nature. Once those cysts become symptomatic, we recommend endoscopic procedure including decompression and biopsy of the cyst with ETV.

Unique MR spectroscopic finding in colloid-like cyst

Cysts morphologically identical to colloid cysts are rarely reported to be located in areas outside the third ventricle. We report the magnetic resonance (MR) imaging and spectroscopic findings in three patients with colloid like cyst located in the ponto-medullary, pre-pontine cistern and suprasellar region. The MR imaging and spectroscopy performed on a 1.5-tesla scanner in three female patients revealed T1 hyperintense mass lesions. A large dominant metabolite peak at 2.0-ppm chemical shift, simulating N-acetylaspartate (NAA) of normal neuronal tissue was detected within the lesion. This peak is probably due to the presence of glycoproteins secreted by the ciliated columnar epithelium lining these cysts. MR spectroscopy of colloid cyst has not been described in the literature and hence the findings in this study will help in the diagnosis of this cystic lesion especially when located at unusual location. The signal characteristics of these cysts in various sequences including diffusion weighted imaging (DWI) and susceptibility weighted imaging (SWI) are also discussed.

Colloid (Enterogenous) Cyst in the Frontal Lobe-Case Report-

A 60-year-old man presented with a left frontal mass lesion incidentally detected at a health check without apparent symptoms. Computed tomography revealed the lesion as homogeneous high density and magnetic resonance (MR) imaging showed the lesion as hyperintense on T(1)-weighted images, isointense on T(2)-weighted images, and hypointense on diffusion-weighted images. T(1)-weighted MR images with gadolinium showed no enhancement of the mass lesion. Cerebral angiography revealed an avascular area around the left frontal lesion. Total removal of the lesion was achieved through a craniotomy without complications. Histological, immunohistochemical, and electron microscopy examinations established the definite diagnosis of colloid cyst.

Endoscopic treatment of thalamic neuroepithelial cysts

✓ Thalamic neuroepithelial cysts are rare lesions of the central nervous system. Surgical management of these lesions has varied and yielded mixed results. The authors identified 10 reported cases in the literature, five of which involved symptomatic lesions. The authors present three unique cases of symptomatic thalamic neuroepithelial cysts associated with hydrocephalus, which were all successfully treated using endoscopic third ventriculostomy and fenestration of the cyst into the third ventricle.

Colloid-like cyst located in the prepontine region

BACKGROUND

The term "colloid cysts" refers to nonneoplastic lesions located in the anterior part of the third ventricle. However, cysts morphologically identical to colloid cysts are found, albeit extremely rarely, through the neuraxis.

CASE DESCRIPTION

We report a case of a 44-year-old man with a short history of headache and 5 years of bilateral hearing loss. Computed tomography (CT) and magnetic resonance imaging (MRI) scans showed an oval lesion located at the anterior surface of the pons. The tumor was excised through a right pterional transsylvian approach. Postoperatively, the hearing deficit remained unchanged. Otherwise, the patient made an excellent recovery. Histopathological examination showed a colloid-like cyst.

CONCLUSIONS

Colloid-like cysts growing in the prepontine region are extremely rare. To date, only two similar cases have been reported in the literature. Patients present with headaches, hearing loss, or blurred vision.