Wk 4, Case 3 - Review

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Report

Patient History
Intraventricular mass. Pre-op evaluation. Headaches.

Findings
Partially enhancing mass with cystic components located in the left ventricle, partially traversing the foramen of Monro on the left. It measures 4.2 cm AP x 2.7 cm trans x 2.3 cm cc. The left ventricular body is expanded and there is mild dilation of the antrum and occipital horns. Mass effect bows the septum pellucidum 6 mm rightward of midline. There are areas of mild restricted diffusion within the lesion. Some areas of susceptibility are also noted.

Scalp fiducial markers are in place. No evidence of acute hemorrhage, ischemia, extra-axial collection or herniation. Basal cisterns are patent. Major intracranial flow voids are preserved. Minimal mucosal thickening is noted in the ethmoid sinuses, sphenoid sinuses and right maxillary sinus. Trace mastoid effusions are present bilaterally. The orbits are unremarkable.

Impressions
Heterogenously enhancing mass with cystic components located in the left ventricle, abutting the septum pellucidum compatible with suspected central neurocytoma. Differential diagnosis included subependymal giant cell tumor, ependymoma, and meningioma but these are much less likely.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 4, Case 3 - Review