Case ReportRuptured Massa Intermedia Secondary to Hydrocephalus
Section snippets
History and Examination
A 52-year-old patient presented with headache with occasional diplopia for 3 months. Magnetic resonance imaging (MRI) showed a contrast-enhanced posterior fossa mass with the beginnings of mild hydrocephalus (Figure 1A). The decision was made to excise the tumor without adjuvant primary management to hydrocephalus. The tumor was resected entirely, without complications.
Postoperative Course
The patient had an uneventful postoperative recovery. The control MRI, performed on first postoperative day (Figure 1B), showed total resection of the tumor without complications as well as resolution of the hydrocephalic changes. It demonstrated also an intact massa intermedia (MI). (Figure 2).
On the third postoperative day, the patient complained of headache then suffered from a rapid deterioration in level of consciousness. A computed tomography scan was performed, which demonstrated a
Discussion
Hemangioblastomas are known to be highly vascular tumors, comprising approximately 3% of all tumors of the central nervous system.1, 2, 3, 4 Because of their vascular nature, these tumors carry a potential greater risk of hemorrhage, which can occur spontaneously, intraoperatively, or postoperatively, which was the case in our patient, where the bleeding occurred on third day postoperative after a postoperative MRI control scan which revealed no related complications.
The MI is a band of
Conclusions
To our knowledge, the described scenario of this patient has never been reported in the literature where rupture of the MI was documented before and after suffering from hydrocephalus. Absent MI is not uncommon in hydrocephalic patients and it is assumed to be as a result of rupture from acute dilatation of the third ventricle. Our case report proves this assumption and documents the presence and absence of the MI before and after developing hydrocephalus.
References (10)
- et al.
Sex differences in the absence of massa intermedia in patients with schizophrenia versus healthy controls
Schizophr Res
(2001) - et al.
Hemangioblastoma of the spinal cord. Review and report of five cases
Arch Neurol
(1976) - et al.
The impact of molecular genetic analysis of the VHL gene in patients with haemangioblastomas of the central nervous system
J Neurol Neurosurg Psychiatry
(1999) - et al.
Radiologic-pathologic correlation: hemangioblastoma
AJNR Am J Neuroradiol
(1992) - et al.
Central nervous system lesions in von Hippel-Lindau syndrome
J Neurol Neurosurg Psychiatry
(1992)
Cited by (5)
Interthalamic Adhesion: Can it be used to Diagnose Idiopathic Intracranial Hypertension?
2023, World NeurosurgeryMassa intermedia of the thalamus: an anatomical study using magnetic resonance imaging
2021, Surgical and Radiologic AnatomyThalamic massa intermedia in children with and without midline brain malformations
2020, American Journal of Neuroradiology
Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.