title: Endoscopic diagnosis of an MRI-occult, low-grade glioma with ependymal dissemination.
abstract: A 21-year-old man presented with triventricular hydrocephalus due to a tectal mass. He underwent an endoscopic third ventriculostomy, and multiple nodules were identified at the floor of the third ventricle intraoperatively. Surgical pathology of one of these lesions demonstrated that the tissue represented a low-grade astrocytoma. The case highlights the existing potential of neuroendoscopy to reveal neuroimaging-occult lesions, in spite of the significant advances of MRI. Furthermore, the combination of the age of the patient, the nonenhancing MRI appearance, and the multifocality of the lesions constitutes a rare and interesting neoplastic presentation within the brain. The constellation of findings likely represents dissemination of a low-grade tectal glioma via the CSF compartment.
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Margetis
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Prajwal
authors.initials: P
authors.lastname: Rajappa
authors.affiliation: Weill Cornell Medical College, New York, New York.
authors.forename: William
authors.initials: W
authors.lastname: Cope
authors.affiliation: Pathology and Laboratory Medicine, Weill Cornell Medical College, NewYork-Presbyterian Hospital; and.
authors.forename: David
authors.initials: D
authors.lastname: Pisapia
authors.affiliation: Departments of 1 Neurosurgery and.
authors.forename: Mark M
authors.initials: MM
authors.lastname: Souweidane
mesh_terms: D001254:Astrocytoma / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D002551:Cerebral Ventricle Neoplasms / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D004724:Endoscopy; D004805:Ependyma / Q000473:pathology*; D005188:False Negative Reactions; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D015173:Supratentorial Neoplasms / Q000175:diagnosis / Q000473:pathology*; D003336:Tectum Mesencephali / Q000473:pathology*; D020542:Third Ventricle / Q000473:pathology* / Q000601:surgery; D014696:Ventriculostomy; D055815:Young Adult
keywords: ETV = endoscopic third ventriculostomy; astrocytoma; cerebrospinal fluid; glioma; neoplasm metastasis; neuroendoscopy; oncology; third ventricle