Multiple supratentorial subependymomas causing obstructive hydrocephalus

BMJ Case Rep. 2017 Jun 3:2017:bcr2016215625. doi: 10.1136/bcr-2016-215625.

Abstract

Introduction: Subependymomas are benign intraventricular tumours that most often occur asymptomatically and are found incidentally on autopsy. Symptomatic examples requiring surgical intervention are exceedingly rare.

Case presentation: A 55-year-old man with no history of neurological symptoms presented with multiple episodes of loss of consciousness and increasing headaches. MRI revealed a lobulated intraventricular mass centred at the right Foramen of Monro. Obstructive hydrocephalus with localised midline shift and a second lesion were noted. Right frontal craniotomy with total removal via transcortical resection was performed.

Discussion: Symptomatic subependymomas generally present with signs of hydrocephalus due to obstruction of cerebrospinal fluid pathways. There is only one other reported case of multifocal subependymomas in a symptomatic patient. An example of multiple supratentorial subependymomas causing obstructive hydrocephalus has not been previously reported.

Conclusions: Multiple subependymomas are rare. Judicious surgical management with full excision led to symptomatic improvement in our patient.

Keywords: Hydrocephalus; Neuroimaging; Neurooncology; Neurosurgery.

Publication types

  • Case Reports

MeSH terms

  • Cerebral Ventricle Neoplasms / complications
  • Cerebral Ventricle Neoplasms / diagnosis*
  • Cerebral Ventricle Neoplasms / diagnostic imaging
  • Cerebral Ventricles*
  • Craniotomy
  • Diagnosis, Differential
  • Glioma, Subependymal / complications
  • Glioma, Subependymal / diagnosis*
  • Glioma, Subependymal / diagnostic imaging
  • Humans
  • Hydrocephalus / etiology*
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged