PMC9990795_01
Magnetic resonance imaging T1-CE (contrast-enhanced) axial images (a-c), coronal image (d), and sagittal image (e). The tumor consists of a solid component and a cystic component, extending from the intrasellar turcica to the suprasellar turcica. It has also spread to both internal carotid arteries and the right cavernous sinus. The cystic components of the tumor (arrows) occupy the third ventricle causing acute hydrocephalus.
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F1
The cystic component of the tumor occupied the third ventricle and obstructed the foramen of Monro, causing acute hydrocephalus [Figure 1].
(a): The route of entry of the flexible neuroendoscope is illustrated. First, the right ventricle was punctured (1) and then fenestration of the septum pellucidum was performed to enter the left ventricle (2). The cyst was then removed from the left foramen of Monro (3). (b): A purple-colored cystic wall blocking the foramen of Monro (asterisk) was observed. cp: Choroid plexus. (c) The septum pellucidum was fenestrated by RAF electrode. sp: septum pellucidum. (d) Left foramen of Monro enlarged by the cyst (asterisk). cp: Choroid plexus: Cyst wall is cauterized with RAF electrodes (e), and perforated with biopsy forceps (f). The cyst wall is excised with biopsy forceps (g). (h) Image of the third ventricle obtained after cyst removal. The mammillary body (white arrow) and aqueduct are confirmed (black arrow).
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F2
A planned right anterior horn puncture was performed under navigational guidance [Figure 2a]. A purple cystic wall was observed blocking the right foramen of Monro [Figure 2b]. Osaka, Japan) [Figure 2c]. Observation of the left lateral ventricle revealed that the left foramen of Monro was expanded by the tumor, larger than the right foramen of Monro [Figure 2d]. The cyst wall was cauterized with RAF electrodes [Figure 2e] and perforated using biopsy forceps [Figure 2f]. The cyst wall was excised as much as possible with biopsy forceps [Figure 2g]. After the cyst had shrunk, the third ventricle was observed and the mammillary body and aqueduct could be identified [Figure 2h].
CT on postoperative day 7, the tumor in the third ventricle has shrunk, and the acute hydrocephalus has resolved.
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F3
Head CT taken 7 days after surgery showed improvement in acute hydrocephalus and reduction in ventricle size [Figure 3].
Magnetic resonance imaging T1CE obtained 2 months postoperatively. The cystic component of the tumor disappeared, and ventricular enlargement was not observed. The solid component of the tumor shrank compared to the time of initial diagnosis.
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F4
MRI taken 2 months later showed that the tumor had shrunk, and the hydrocephalus had disappeared [Figure 4].