PMC8382088_01
Preoperative Lancaster red-green test, attaching the diplopia to bilateral sixth cranial nerve palsy.
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fig1
Preoperative brain MRI. (A) Sagittal tbl1 WI, (B) sagittal tbl2 WI, (C) sagittal tbl1 WI injected, (D) axial FLAIR passing through the Sylvius aqueduct, (E) axial FLAIR passing through the lateral ventricles' frontal horns. The lesion in the tectum appears isointense on tbl1 WI and hyperintense on tbl2 WI and FLAIR images, with remarkable enhancement after gadolinium injection (arrow). The lesion caused an obstructive hydrocephalus (E).
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fig2
This lesion was applying a pressure on the aqueduct of the Sylvius, causing obstructive, active triventricular dilation (Figure 2).
Postoperative Lancaster red-green test, showing disappearance of the diplopia.
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fig3
Postoperatively, the patient's condition improved clinically and diplopia disappeared (Figure 3).
15 months postoperative MRI. (A) Axially injected tbl1 WI, (B) sagittal tbl2 WI, (C) axial FLAIR. The tectum lesion disappeared completely (arrow), with appearance of probable new location in the hypothalamus region (arrow head) and stabilization of the hydrocephalus.
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fig4
However, there was a suspected pituitary stalk and hypothalamus hypersignal on FLAIR sequences, but there was no neurological or endocrine correlation (Figure 4).