Article
Dorsally exophytic brain stem glioma of the pineal region
Dorsal exophytisches Hirnstammgliom der Pinealisloge
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Published: | May 8, 2006 |
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Objective: Pineal gland lesions are rare and gliomas affecting this region are an exceptional finding. The authors report an unusual case of a dorsally exophytic brain stem astrocytoma arising in the pineal region and presenting with acute onset and haematoma.
Methods: A 16-year-old male was admitted comatose after acute onset and progressive diminution of vigilance. Cranial computed tomography showed a lesion of the pineal region causing occlusive hydrocephalus. After implantation of an external ventricle catheter to treat acute hydrocephalus, an additional magnetic resonance imaging disclosed a large tumour originating from the tectum and expanding dorsally into the pineal region. Microsurgical excision via a median suboccipital craniotomy and infratentorial-supracerebellar approach confirmed the diagnosis of a dorsally exophytic brain stem astrocytoma associated with tumour bleeding and led to resolution of the patients’ symptoms.
Results: A unique case of an initially unexpected dorsally exophytic brain stem glioma associated with haemorrhage and acute onset of symptoms is described that could be successfully treated and confirmed by microsurgery.
Conclusions: Unusual locations and appearances of dorsally exophytic brain stem gliomas may cause diagnostic difficulties. They have to be considered in differential diagnosis of lesions in the pineal region to allow adequate surgical treatment.