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NEUROIMAGES
Year : 2016  |  Volume : 64  |  Issue : 4  |  Page : 834-835

Third ventricular craniopharyngioma


Department of Neurosurgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Dr. Alugolu Rajesh
Department of Neurosurgery, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad - 500 082, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0028-3886.185370

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How to cite this article:
Rambarki O, Rajesh A. Third ventricular craniopharyngioma. Neurol India 2016;64:834-5

How to cite this URL:
Rambarki O, Rajesh A. Third ventricular craniopharyngioma. Neurol India [serial online] 2016 [cited 2019 Nov 16];64:834-5. Available from: http://www.neurologyindia.com/text.asp?2016/64/4/834/185370


A 50 year (case 1) and a 27 year (case 2) male patient presented with features of raised intracranial headache without localisation. There were neither hormonal abnormalities nor visual field defects.

MRI showed [Case 1-[Figure 1]a, [Figure 1]b, [Figure 1]c, [Figure 1]d] a lesion occupying the third ventricular region which was homogenously hypointense on T1W and hyperintense on T2W imaging with peripheral enhancement on contrast imaging. The sella and suprasellar cisterns were well clear off the lesion {blue arrows; 1c- coronal; 1d- sagittal}.
Figure 1: MRI shows a lesion occupying the third ventricular region which was homogenously hypointense on T1W and hyperintense on T2W imaging with peripheral enhancement on contrast imaging. The sella and suprasellar cisterns were well clear off the lesion {blue arrows; (c) Coronal (d) Sagittal}

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In the second case [Figure 2]a, [Figure 2]b, [Figure 2]c, [Figure 2]d, the MRI showed a lesion in the third ventricle which was hypo on T1 and hyper on T2W imaging and uniformly enhancing on contrast images with extension into frontal horn. The sella and suprasellar regions were well clear off the lesion {blue arrows; 2c- coronal; 2d- sagittal}.
Figure 2: MRI shows a lesion in the third ventricle which was hypo on T1 and hyper on T2W imaging and uniformly enhancing on contrast images. It had anextension into thefrontal horn. The sella and suprasellar regions were well clear off the lesion {blue arrows; (c) Coronal (d) Sagittal}

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Histopathological examination showed a heterogenous solid-cystic lesion with stratified squamous and cuboidal lining, with myxoid stroma and keratin pearls suggestive of a craniopharyngioma [Figure 3]a and [Figure 3]b.
Figure 3: Histopathological sections showing stratified squamous epithelium (a, Blue arrow); and, areas of cuboidal epithelium, myxoid stroma, cystic spaces and wet keratin (b) seen at ×10 magnification suggestive of a craniopharyngioma b

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Migliori et al., proposed the radiological criteria to differentiate a primarily third ventricular craniopharyngioma from a suprasellar mass invaginating the floor of third ventricle. Coronal CT or MRI shows an intact third ventricular floor, patent suprasellar cistern, normal pituitary gland and no sellar abnormalities.[1]

Craniopharyngiomas comprise of 2-4% of all intracranial tumors. The tumor is usually confined to the suprasellar region in 21%; it may be entirely sellar in 4%; and, may be present in suprasellar region with sellar extension in 75% cases. Intraventricular craniopharyngiomas are rare, mostly seen in the elderly patients [2] (and hence, no description of them in percentages exists).

It is important to know the exact location of the lesion, and its clinical presentation. The operative approach to these lesions would be different from that performed for lesions primarily involving the sellar/suprasellar region extending into the third ventricle [Table 1], video- subfrontal trans-lamina terminalis approach].
Table 1: Salient differences between purely third ventricular versus suprasellar craniopharyngioma with a third ventricular extension

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Migliori A, Calzolari F, Marzola A, Ghadirpour R, Migliori M. Intrinsic third ventricle craniopharyngioma. Child's Nerv Syst 1992;8:56-8.  Back to cited text no. 1
    
2.
Behari S, Banerji D, Mishra A, Sharma S, Sharma S, Chhabra DK, et al. Intrinsic third ventricular craniopharyngiomas: Report on six cases and a review of the literature. Surg Neurol 2003;60:245-53.  Back to cited text no. 2
    


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  [Figure 1], [Figure 2], [Figure 3]
 
 
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