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Management challenges associated with a pineal region chordoma: illustrative case

Ji-Eyon Kwon, So Young Ji, Kihwan Hwang, Kyu Sang Lee, Gheeyoung Choe, Chae-Yong Kim, and Jung Ho Han

hyperintense on T2-WI ( C ) with heterogeneous contrast enhancement ( D ). The lesion in the right thalamus was identified as a subacute hematoma. E: PET with 2-deoxy-2-[fluorine-18]fluoro- d -glucose shows a hypermetabolic lesion of the pineal gland ( arrow ); the right thalamic lesion was identified as a metabolic defect. Surgical Procedure Initially, endoscopic third ventriculostomy (ETV) was performed to resolve the obstructive hydrocephalus. Subsequently, resection of the tumor was planned, and the patient was discharged. Three weeks after the ETV, the

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Diffusely invasive supratentorial rosette-forming glioneuronal tumor: illustrative case

Brittany Owusu-Adjei, Constance J Mietus, Jeewoo Chelsea Lim, William Lambert, Rrita Daci, David Cachia, Thomas W Smith, and Peter S Amenta

+ – – + Biopsy & radiation – 49 Lu et al., 2009 42 79 3rd ventricle + – + – ETV NA Ant = anterior; ETV = endoscopic third ventriculostomy; NA = not available; STR = subtotal resection; VPS = ventriculoperitoneal shunt; – = no; + = yes. Imaging Characteristics Rosette-forming glioneuronal tumor typically arises in the fourth ventricle and can invade surrounding posterior fossa structures and rarely the spinal cord. Rarely, lesions can involve supratentorial structures including the pineal region, optic chiasm, and septum pellucidum

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Malignant transformation of a cerebral dermoid cyst into a squamous cell carcinoma with malignant intraperitoneal spreading along a ventriculoperitoneal shunt: illustrative case

Robert C. Nickl, Vera Nickl, Magnus Schindehütte, Camelia-Maria Monoranu, Ralf-Ingo Ernestus, and Mario Löhr

Although the prevalence of shunt related metastases is still unknown especially in the case of obstructive hydrocephalus, the use of an endoscopic third ventriculostomy (ETV) is an alternative treatment option. 21 To the best of our knowledge, this is the first case of an extracerebral spread of a malignant DC, which occurred through a previously implanted VP shunt due to hydrocephalus after presumed cyst rupture. Lessons We emphasize to take malignant transformation as a differential diagnosis into account, if leptomeningeal contrast-enhancement is present in

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Subtle magnetic resonance imaging differences in tegmental pilocytic astrocytomas as a caution against attempting gross-total resection: illustrative cases

Tariq Al-Saadi, Steffen Albrecht, Jean-Pierre Farmer, Daniela Toffoli, Christine Saint-Martin, Nada Jabado, and Roy W. R. Dudley

on the T2-weighted and FLAIR sequences, and it showed very faint and patchy gadolinium enhancement. There was no restricted diffusion. His neurological examination result was normal, except for his subtle eye movement abnormalities with partial right third-nerve palsy. An uneventful endoscopic third ventriculostomy was performed the same day. It was believed that this tumor was most likely a PA. Upon discussion with our neuro-oncology group, surgery was recommended as the best option for long-term tumor control and to address his progressive symptoms. FIG. 2

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Mixed germ cell tumor infiltrating the pineal gland without elevated tumor markers: illustrative case

Koji Shiomi, Yoshiki Arakawa, Sachiko Minamiguchi, Haruki Yamashita, Yukinori Terada, Masahiro Tanji, Yohei Mineharu, Katsutsugu Umeda, Megumi Uto, Junko Takita, Hironori Haga, Takashi Mizowaki, and Susumu Miyamoto

isointense tumor in the pineal region. Biopsy in a Local Hospital The patient was treated with endoscopic third ventriculostomy in combination with a tumor biopsy in a local hospital. On histopathological examination, tumor specimens comprised a cystic portion and a solid portion ( Fig. 2A and B ). Histopathological examination showed the cystic portion was lined by an epithelial monolayer with no atypia ( Fig. 2A and C ). The solid portion comprised sheets of uniform cells with round nuclei. The Ki-67 labeling index was higher than 1% in some parts ( Fig. 2C

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Traumatic sacral dermoid cyst rupture with intracranial subarachnoid seeding of lipid particles: illustrative case

Alexander Perdomo-Pantoja, Hesham Mostafa Zakaria, Brendan F. Judy, Jawad M. Khalifeh, Jose L. Porras, Tej D. Azad, Brian Y. Hwang, Timothy F. Witham, Chetan Bettegowda, and Nicholas Theodore

treated with antibiotics. † Surgery was intended, but the patient died of massive pulmonary embolus preoperatively. ‡ Hydrocephalus treated with ventriculoperitoneal shunt. § Meningism treated with analgesics. ¶ Hydrocephalus treated with third ventriculostomy. All 21 patients were adults; the mean age was 41.1 (standard deviation, 17.8) years, with a strong male predominance (7:1 ratio). The spinal dermoid cysts were mostly located in the lumbar spine (11 of 21 [52.4%]); others were located in the thoracolumbar (5 of 21 [23.8%]), sacral (3 of 21 [14

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Endoscopic resection of a giant colloid cyst in the velum interpositum: illustrative case

Mahdi Arjipour, Mohammad Gharib, and Mohamadmehdi Eftekharian

into consideration. Operation The patient underwent surgery through an endoscopic approach to the lesion. After entering the ventricular space from the right side, the lesion was observed. At first, a cerebrospinal fluid sample was taken and an endoscopic third ventriculostomy was undertaken for hydrocephalus treatment. Then, after the mass wall opening at the superior part, there was a firm nonsuctionable solid gray-yellow material inside the lesion, which was not typical for a colloid cyst. Thus, the solid lesion content was resected in a piecemeal manner

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Bifocal germ cell tumor of pineal germinoma and neurohypophyseal embryonal carcinoma: illustrative case

Yu Naruse, Shinya Jinguji, Ryo Hiruta, Ayako Toda, Kenichiro Nagai, Shingo Kudo, Hideki Sano, Rei Sekine, Osamu Suzuki, Mudathir Bakhit, and Masazumi Fujii

hormone; GH = growth hormone; IGF-1 = insulin-like growth factor–1; LH = luteinizing hormone; PRL = prolactin; TSH = thyroid stimulating hormone; T3 = triiodothyronine; T4 = thyroxine. Progress of Treatment Considering the imaging findings and tumor marker values, a diagnosis of GCT was suspected, leading to the decision to perform emergency procedures, including endoscopic third ventriculostomy (ETV), tumor biopsy, and ventricular drainage. During the operation, gross examination of the neurohypophyseal and pineal tumors revealed contrasting characteristics