title: Spontaneous acute hemorrhage within a subependymoma of the lateral ventricle: successful emergent surgical removal through a frontal transcortical approach.
abstract: INTRODUCTION. Subependymomas are benign neoplasms intimately related to the ventricular system which only exceptionally associate hemorrhagic events. We present neuroradiological and pathological evidences of intratumoral hemorrhage within a single case of subependymoma operated on at our institution. Additionally we analyze retrospectively the well-defined reports of similar cases published in the scientific literature. CASE REPORT. A 71-year-old man on anticoagulant therapy presented with abrupt and progressive deterioration of his level of consciousness. Emergent computed tomography and magnetic resonance imaging evidenced signs of acute bleeding within a mass located at the frontal horn of the left lateral ventricle, producing obstructive biventricular hydrocephalus. The lesion was immediately and completely removed through a left frontal transcortical approach. Pathological diagnosis was consistent with subependymoma displaying areas of microhemorrhage. After surgery the patient developed global anterograde and retrograde amnesia. CONCLUSIONS. A spontaneous hemorrhagic event within an asymptomatic lateral ventricle subependymoma can result in a surgical emergence as a consequence of sudden obstruction of cerebrospinal fluid pathways. Prompt and radical surgical removal of the mass, which allows a rapid resolution of hydrocephalus and prevents the risk of rebleeding, may constitute the safest management strategy.
authors.affiliation: Department of Neurosurgery. Ramón y Cajal University Hospital. La Princesa University Hospital. Madrid, Spain. rocamo@gmail.com
authors.forename: R
authors.initials: R
authors.lastname: Carrasco
authors.forename: J M
authors.initials: JM
authors.lastname: Pascual
authors.forename: M
authors.initials: M
authors.lastname: Navas
authors.forename: J
authors.initials: J
authors.lastname: Fraga
authors.forename: R
authors.initials: R
authors.lastname: Manzanares-Soler
authors.forename: R G
authors.initials: RG
authors.lastname: Sola
mesh_terms: D000368:Aged; D002543:Cerebral Hemorrhage / Q000209:etiology / Q000601:surgery*; D002551:Cerebral Ventricle Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D018315:Glioma, Subependymal / Q000150:complications / Q000473:pathology / Q000601:surgery; D006801:Humans; D020547:Lateral Ventricles / Q000473:pathology / Q000601:surgery; D008297:Male; D019635:Neurosurgical Procedures / Q000379:methods*; D016896:Treatment Outcome