J Korean Neurosurg Soc.  2017 May;60(3):375-379. 10.3340/jkns.2014.0808.026.

Endoscopic Treatment of an Adult with Tegmental Astrocytoma Accompanied by Cerebrospinal Fluid Dissemination

• Lu R
• Li C
• Wang X
• Zhang Y

• KMID: 2382775
• DOI: http://doi.org/10.3340/jkns.2014.0808.026

Abstract

Midbrain gliomas are relatively rare neoplasms with a generally benign prognosis, with dissemination or metastasis not previously reported. We describe here a woman, in whom magnetic resonance imaging scans showed hydrocephalus and a tegmental lesion in the upper aqueduct. Endoscopic third ventriculostomy and biopsy were performed; during surgery, a second small lesion was observed in the infundibular recess. Histologically, the two lesions had the characteristics of low grade astrocytoma, suggesting that the midbrain astrocytoma may have been disseminated via the cerebral spinal fluid to the infundibular recess. Postoperatively this patient received radiotherapy for nearly one month. Although patients with these tumors are not usually administered adjunctive therapy, radiation and, combined modality therapy, including surgery, radiotherapy, and chemotherapy, may be beneficial in patients with midbrain gliomas with dissemination.

Keyword

Neuroendoscope; Astrocytoma; Tegmentum; Dissemination; Biopsy

MeSH Terms

Adult*
Astrocytoma*
Biopsy
Cerebrospinal Fluid*
Combined Modality Therapy
Drug Therapy
Female
Glioma
Humans
Hydrocephalus
Magnetic Resonance Imaging
Mesencephalon
Neoplasm Metastasis
Neuroendoscopes
Prognosis
Radiotherapy
Ventriculostomy

Figure

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  Fig. 1 Magnetic resonance (MR) imaging in our patient. A: Axial T2 weighted MR image showing a lesion in the dorsal midbrain (arrow) and enlargement of the ventricles. B: Axial T1 weighted MR image showing a lesion in the dorsal midbrain (arrow). C: Sagittal T1 weighted MR image showing a lesion in the tegmentum (arrow) resulting in obstruction of the aqueduct. D: Sagittal T1 weighted MR image with gadolinium showing a lesion in the tegmentum (arrow). E: Diffuse weighted imaging showing a lesion in the third ventricle (arrow). F: Coronal T1 weighted MR image showing that the left lateral ventricle is larger than the right. G: Postoperative sagittal T1 weighted MR image showing the tumor in the tegmentum (arrow). H: Postoperative sagittal T1 weighted MR image with gadolinium showing the tumor in the tegmentum (arrow).

• 

  Fig. 2 Endoscopic findings in our patient. A: Image showing a neoplasm (arrow) in the fundibular recess between the lamina terminalis (1) and the floor of the third ventricle (2); 3 and 4 are the right and left cerebral peduncles, respectively. B: Biopsy of the tumor (T) using a microforceps (3). The lamina terminalis (1) and the floor of the third ventricle (2) were anterior and posterior to the tumor, respectively. C: Endoscopic fenestration (arrow) near the tumor (T). D: Obstruction of the aqueduct by a lesion (bottom arrow); the top arrow indicates the position of the third ventriculostomy. E: Close-up view of the tumor (T) in the brainstem (T). F: biopsy of the tumor (T) using a microforceps. G: Endoscopic view of the left lateral ventricle; the left interventricular foramen (1) was confirmed. Fenestration (3) of the septum pellucidum (4) was performed, making the contralateral choroid plexus (4) visible. H: Endoscopic view of the right lateral ventricle following fenestration of the septum pellucidum, the choroid plexus in the right ventricle (1), the right interventricular foramen (black arrow), and the vena thalamostriata (white arrow). BS: brain stem.

• 

  Fig. 3 Histological examination of the tumor tissue following hematoxylin and eosin staining (H&E, ×200).

Reference

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