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Case Reports
. 2017 Apr 26:8:53.
doi: 10.4103/sni.sni_1_17. eCollection 2017.

A case of a cerebral cavernous malformation of the third ventricle that caused the syndrome of inappropriate secretion of antidiuretic hormone

Takahiro Sasaki  1 , Nobuhide Hayashi  1 , Nagatsuki Tomura  1 , Eisaku Tsuji  1 , Hideo Okada  1 , Toshikazu Kuwata  1
Affiliations
Case Reports

A case of a cerebral cavernous malformation of the third ventricle that caused the syndrome of inappropriate secretion of antidiuretic hormone

Takahiro Sasaki et al. Surg Neurol Int. .

Abstract

Background: Cerebral cavernous malformations (CCMs, also known as cavernous hemanigiomas) of the third ventricle are uncommon. Here, we present a rare case of a CCM that caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH).

Case description: A 68-year-old man presented with acute-onset cognitive and memory disturbance. Endocrinological examinations revealed hyponatremia due to SIADH. Computed tomography indicated a high-density mass in the third ventricle that caused left unilateral hydrocephalus due to obstruction of the foramen Monroe. On magnetic resonance imaging, the mass showed high intensity in both T1 and T2-weighted images and low intensity in susceptibility-weighted images, suggesting subacute intralesional hemorrhage. We completely excised the mass via a basal interhemispheric translamina terminalis approach. Intraoperatively, the mass adhered tightly to the left hypothalamus, which was supposed to the origin and was well circumscribed from the surroundings. The histopathological diagnosis was CCM, and his SIADH improved after the operation.

Conclusion: We presented a rare case of a CCM in the third ventricle that caused SIADH, which improved after complete excision of the mass via a basal interhemispheric translamina terminalis approach.

Keywords: Cavernous hemangioma; SIADH; cerebral cavernous malformation; third ventricle.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Preoperative computed tomography scan (a) shows a high-density mass in the third ventricle, which obstructed the foramen Monroe, causing left unilateral hydrocephalus. On MRI, the mass shows high intensity in both T1-weighted images (b) and T2-weighted images (c) and low intensity in susceptibility-weighted images (d), suggesting subacute intralesional hemorrhage. The mass is not enhanced with gadolinium (e: Axial, f: Coronal image)
Figure 2
Figure 2
Surgical view shows that a xanthochromic and multilobulated tumor (white asterisk) in the third ventricle, which adhered to the left hypothalamus (black asterisk)
Figure 3
Figure 3
Photomicrograph of the surgical specimen stained with hematoxylin and eosin shows variant vessels, hematomas, and hemosiderin (a and b). Elastica van Gieson staining shows thin blood vessel walls containing endothelium and a collagenous adventitia (c). CD34-immunoreactivity is identified in the endothelial-like cells (d)
Figure 4
Figure 4
Postoperative T1-weighted images show that the mass is completely excised and that left unilateral hydrocephalus improved
See this image and copyright information in PMC

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