Elsevier

World Neurosurgery

Volume 97, January 2017, Pages 749.e7-749.e10
World Neurosurgery

Case Report
Ruptured Massa Intermedia Secondary to Hydrocephalus

https://doi.org/10.1016/j.wneu.2016.10.131Get rights and content

Background

We report a case of ruptured massa intermedia (MI) as a sequela of hydrocephalus.

Case Description

A single case report is presented describing the sequelae of tumor bed hematoma after a posterior fossa hemangioblastoma resection in which the patient bled 3 days after surgery, resulting in secondary hydrocephalus and subsequently dilatation of the third ventricle, which resulted in rupture of the MI. The patient was managed on emergency basis with an external ventricular drain then endoscopically with a third ventriculostomy and clot extraction.

Conclusions

Absent MI is not uncommon in hydrocephalic patients, and it is assumed to be the 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.

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.

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Cited by (5)

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.

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