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Case Reports
. 2022 Jul 27:9:231-236.
doi: 10.2176/jns-nmc.2021-0413. eCollection 2022.

A Case of Lateral Ventricular Subependymoma with Intratumoral Hemorrhage via Neuroendoscopic Surgery

Yutaka Fuchinoue  1 , Kei Uchino  1 , Sayaka Terazono  1 , Noyuki Harada  1 , Kosuke Kondo  1 , Nobuo Sugo  1
Affiliations
Case Reports

A Case of Lateral Ventricular Subependymoma with Intratumoral Hemorrhage via Neuroendoscopic Surgery

Yutaka Fuchinoue et al. NMC Case Rep J. .

Abstract

Subependymoma (SE) is a rare, usually asymptomatic, brain tumor predominantly affecting older adults and occurring in the fourth and lateral ventricles. We report a rare case of SE with intratumoral hemorrhage that could be removed by neuroendoscopy. The 81-year-old patient had been followed as an outpatient for 10 years due to an intraventricular tumor. It did not grow over the patient's lengthy follow-up. The patient was transferred to our hospital after he fainted near his home; at the time of admission, he had mild consciousness disturbance, and his Glasgow Coma Scale score was 10 points (E3V3M4). Computed tomography showed intratumoral hemorrhage and slight ventricular enlargement. Magnetic resonance (MR) imaging showed a 4 cm-sized tumor in the anterior horn of the right lateral ventricle. The lesion appeared as a mixed-intensity solid tumor and showed irregular enhancement with gadolinium. The patient underwent neuroendoscopic tumor resection on the 30th day of the patient's hospital stay. A histopathological examination revealed small tumor cells with round nuclei scattered in the glial fibrillary background. Immunostaining was positive for glial fibrillary acidic protein; these findings are consistent with an SE diagnosis. The patient in this study had hypertension and used anticoagulants, risk factors for intratumoral hemorrhage. For intraventricular tumors with bleeding-particularly in older or more physically frail patients-minimally invasive neuroendoscopic surgery should be considered an option for tumor resection.

Keywords: intratumoral hemorrhage; lateral ventricle; neuroendoscope; subependymoma.

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Conflict of interest statement

We have completed and submitted to the Japan Neurosurgical Society our COI self-report for the past 3 years. All authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
MRI 3 months before admission. Axial T1- (A) and T2-weighted (B) magnetic resonance (MR) images show a mixed-intensity tumor. Axial T1-weighted (C) MRI with gadolinium revealing partial enhancement of the tumor.
Fig. 2
Fig. 2
Computed tomography on admission, showing intratumoral hemorrhage and intraventricular hemorrhage.
Fig. 3
Fig. 3
Intraoperative photo: Arrowhead: tumor, Arrow: anterior septal vein, White arrow: thalamostriate vein.
Fig. 4
Fig. 4
A: Photograph showing microcystic degeneration (H&E stain). B: Immunohistochemical staining revealed a positive reaction for glial fibrillary acidic protein.
Fig. 5
Fig. 5
Postoperative MRI with gadolinium showing total removal of the intraventricular tumor.
See this image and copyright information in PMC

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