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.
Adult ; Cerebral Ventricle Neoplasms/diagnosis/pathology/*secondary ; Fourth Ventricle/*pathology ; Glioma/diagnosis/*pathology ; Humans ; Lateral Ventricles/*pathology ; Magnetic Resonance Imaging/methods ; Male ; Third Ventricle/*pathology

Adult ; Biopsy ; Cerebral Ventricle Neoplasms ; diagnosis ; Diagnosis, Differential ; Humans ; Magnetic Resonance Imaging ; methods ; Male ; Neoplasms, Neuroepithelial ; diagnosis ; Third Ventricle ; diagnostic imaging

Adult ; Cerebral Ventricle Neoplasms ; diagnosis ; Female ; Glioma ; diagnosis ; Humans ; Magnetic Resonance Imaging ; Prognosis ; Visual Fields

Neurocytoma, a rare brain tumor, is characterized by a mass located mainly in cerebral ventricles. It is prone to be misdiagnosed as oligodendroglioma or ependymoma due to their similar histopathological features in clinical practice. This study aimed to examine the clinicopathological features and differential diagnosis of central and extraventricular neurocytoma. The clinical and histopathological data of 17 patients (male: female=7:10; age: 4-41 years; mean age: 27.4 years) with central or extraventricular neurocytoma were retrospectively analyzed. These patients showed typical radiological, histopathological and immunohistochemical features of neurocytoma. The tumor tissue was found to be composed of small uniform cells with round nuclei and clear cytoplasm resembling that of oligodendroglioma and ependymoma. Immunohistochemistry revealed the tumor tissues were positive for neuronal markers such as synaptophysin (SYN) and neuronal nuclear antigen (NeuN). It was concluded histopathological features of neurocytoma overlaps with some tumors in the central neural system. Immunopositivity for SYN and NeuN can help differentially diagnose neurocytoma.
Adolescent ; Adult ; Antigens, Nuclear ; metabolism ; Biomarkers, Tumor ; metabolism ; Brain Neoplasms ; pathology ; Brain Stem ; pathology ; Cerebral Ventricle Neoplasms ; pathology ; Child ; Child, Preschool ; Female ; Humans ; Male ; Nerve Tissue Proteins ; metabolism ; Neurocytoma ; pathology ; Retrospective Studies ; Synaptophysin ; metabolism ; Young Adult

Adolescent ; Adult ; Cerebral Ventricle Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Follow-Up Studies ; Fourth Ventricle ; pathology ; Ganglioglioma ; diagnosis ; metabolism ; pathology ; surgery ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Magnetic Resonance Imaging ; Male ; Synaptophysin ; metabolism

Adult ; Basic Helix-Loop-Helix Transcription Factors ; metabolism ; Cerebral Ventricle Neoplasms ; metabolism ; pathology ; surgery ; Female ; Follow-Up Studies ; Fourth Ventricle ; Ganglioglioma ; metabolism ; pathology ; surgery ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Magnetic Resonance Imaging ; Nerve Tissue Proteins ; metabolism ; Oligodendrocyte Transcription Factor 2 ; Rosette Formation ; Synaptophysin ; metabolism ; Young Adult

The authors report a case of 42-year-old woman with an intraventricular tumor in the trigone of the left lateral ventricle. The first operation achieved a microscopically complete resection. The tumor was histologically atypical meningioma. After 26 months, there were recurrences of intraventricular meningioma. Complete resection of the tumor and adjuvant radiation therapy were performed, and the histological diagnosis was malignant meningioma. Sixteen months after the second operation, spinal metastasis in cervicolumbar lesion was diagnosed and a subtotal removal of cervical intradural extramedullary mass was performed. We describe an unusual case of intraventricular malignant meningioma with cerebrospinal fluid-disseminated spinal metastases with review of the clinical courses of previous reports.
Adult ; Cerebral Ventricle Neoplasms ; Female ; Humans ; Lateral Ventricles ; Meningioma ; Neoplasm Metastasis ; Recurrence

OBJECTIVETo investigate the diagnostic method and analyze the result of microneurosurgical treatment for tumors of the fourth cerebral ventricle.

METHODSTumor of the fourth ventricle was clinically diagnosed in 86 patients basing on the preliminary assessment of symptom and CT or MRI findings. Of these 86 patients treated with micro-neurosurgery, the tumors in 62 were totally removed, subtotally in 19, and partially in 5. Forty-two patients received postoperative radiotherapy.

RESULTSThree patients died postoperatively within ten days, and symptoms in 83 were improved after treatment. The average survival period was over 3 years. The pathology included 32 medulloblastomas, 23 ependymoma, 15 astrocytoma, 10 hemangiblastomas, 2 choroid plexus papillomas, and 4 epidermoid cysts.

CONCLUSIONMedulloblastoma, astrocytoma and hemangiblastoma are suggested to be removed totally whenever technically possible according to the site, character and volume of the tumor. For ependymoma, if close to the brain stem, is recommended to be subtotally removed. Postoperative radiotherapy may be beneficial for malignant types.

Adolescent ; Adult ; Aged ; Astrocytoma ; diagnosis ; diagnostic imaging ; surgery ; Cerebral Ventricle Neoplasms ; diagnosis ; radiotherapy ; surgery ; Child ; Child, Preschool ; Combined Modality Therapy ; Ependymoma ; diagnosis ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Fourth Ventricle ; pathology ; radiation effects ; surgery ; Hemangioblastoma ; diagnosis ; diagnostic imaging ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Medulloblastoma ; diagnosis ; diagnostic imaging ; surgery ; Microsurgery ; methods ; mortality ; Middle Aged ; Neoplasm Recurrence, Local ; Survival Analysis ; Survival Rate ; Tomography, X-Ray Computed

OBJECTIVETo study the clinicopathologic features of pilomyxoid astrocytoma (PmA).

METHODSThe clinical and pathologic features in 3 cases of PmA were analyzed. Immunohistochemical study for glial fibrillary acidic protein (GFAP), CD34 and Ki-67 was performed on paraffin-embedded sections by standard EnVision method.

RESULTSAll the 3 cases occurred in female patients at the age of 10 months, 10 years and 19 years respectively. Two cases were located in the third ventricle, while the remaining case was located at the optic pathway. Histologically, the tumor was composed of bipolar spindle cells setting in a strikingly mucinous background. There was a marked proliferation of vessels within the tumor. In some areas, the tumor cells exhibited an angiocentric growth pattern. The biphasic pattern noted in a classic pilocytic astrocytoma was not found in PmA. Rosenthal fibers and eosinophilic granular bodies were also not identified. Immunohistochemcal study showed that the tumor cells were diffusely positive for GFAP. The Ki-67 labeling index measured less than 1%. CD34 highlighted mainly the vascular networks.

CONCLUSIONSPmA is a distinctive variant of pilocytic astrocytoma with subtle histologic differences. Compared with conventional pilocytic astrocytoma, PmA behaves more aggressively. Some cases tend to occur in older children and adolescents. Immunohistochemical study for GFAP is helpful in differential diagnosis.

Antigens, CD34 ; metabolism ; Astrocytoma ; metabolism ; pathology ; surgery ; Cerebral Ventricle Neoplasms ; metabolism ; pathology ; surgery ; Child ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Glial Fibrillary Acidic Protein ; metabolism ; Humans ; Immunohistochemistry ; Infant ; Ki-67 Antigen ; metabolism ; Magnetic Resonance Imaging ; Optic Nerve Glioma ; metabolism ; pathology ; surgery ; Third Ventricle ; metabolism ; pathology ; Tomography, X-Ray Computed ; Young Adult

BACKGROUNDIn recent years, keyhole microsurgery has become an important subject of modern minimally invasive neurosurgery. In this study, minimally invasive techniques avoiding unnecessary tissue injuries were applied to refine traditional approaches for the removal of third ventricular tumors within a limited operative filed.

METHODSIndividualized keyhole approaches were designed according to the characteristics of third ventricular tumors and their growth patterns. A series of keyhole approaches such as supraorbital subfrontal approach, infratentorial supracerebellar approach, interhemispheric transcallosal approach, pterional approach were taken to enter the third ventricle anteriorly, posteriorly, superiorly or laterally, respectively. A total of 34 removed tumors in or extended into the third ventricle included 11 craniopharyngiomas, 10 pituitary adenomas, 2 pinealomas, 1 cholesteatoma, 3 germinomas, and 7 gliomas.

RESULTSTotal tumor resection was done in 27 (79.4%) of the patients, and subtotal resection in 7 patients (20.6%). Residual tumor was due to tight adherence of germinoma to the vein of Galen (1 patient), craniopharyngioma to the pituitary stalk (3), supratentorial extension of pineal region gliomas (1), suprasellar extension of gliomas (1) and giant pituitary adenoma (1). Complications such as brain contusion, postoperative hemorrhage and infection were not associated with keyhole approaches. Extended incision or enlarged bone flap was not made because of episode during operation or inadequate exposure.

CONCLUSIONSKeyhole approaches are safe, effective and minimally invasive in the surgical treatment of tumors deeply seated in the third ventricle. Individualized keyhole approach ensures a successful treatment. Tumors in the upper middle part of the third ventricle can be exposed by the interhemispheric transcallosal keyhole approach. Tumors of the posterior third ventricle may be well exposed by the infratentorial supracerebellar keyhole approach. Tumors of the anterior third ventricle can be entered by either a supraorbital subfrontal keyhole approach or a pterional keyhole approach.

Adolescent ; Adult ; Cerebral Ventricle Neoplasms ; surgery ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Neurosurgical Procedures ; methods ; Third Ventricle ; surgery