Craniocervical intradural pseudotumor causing bulbomedullary compression

Abstract

Background: Pseudotumors are rare lesions that may cause compression of adjacent neural structures. Treatment options range from conservative management to surgical intervention.

Case description: A 59-year-old female presented with a 3-month history of headaches, difficulty speaking, swallowing, gait disturbance, and progressive left-sided weakness. Her examination confirmed left-sided tetraparesis. The cervical magnetic resonance showed a right-sided mass compressing the bulbomedullary junction. Through a modified right-sided far lateral craniotomy, an intradural "pseudotumor" was removed. Postoperatively, the patient's symptoms gradually improved. Histopathological analysis revealed an acellular fibrocartilaginous mass consistent with the diagnosis of pseudotumor.

Conclusion: Pseudotumors at the craniocervical junction may cause progressive tetraparesis readily resolved following gross total surgical excision.

Keywords: Bulbomedullary compression; Craniocervical pseudotumor; Far lateral craniotomy; Myelopathy.

Figure 1:

(a) Preoperative sagittal T2-weighted MRI sequence revealing a hyperintense lesion (arrow) located at the craniocervical junction that extends from the tip of the odontoid process to the base of C2. (b) Preoperative axial T2-weighted MRI sequence showing the hyperintense lesion (arrow) with right-sided compression of the bulbomedullary transition.

Figure 2:

(a) Intraoperative view of the lesion. A - Right posterior inferior cerebellar artery; B - Right vertebral artery; C - Medullary origin of the right XI nerve. (b) Intraoperative view of the lesion after opening of the capsule.

Figure 3:

(a) Three-month postoperative sagittal T2-weighted MRI sequence showing total resection of the lesion with no complications. (b) Three-month postoperative axial T2-weighted MRI sequence with complete resection of the lesion lateral to the bulb.

Figure 4:

Hematoxylin and eosin stain (at ×100 magnification): Small fragments of fibrocartilaginous tissue, with recognizable degenerative elements, such as fibrin deposits and cholesterol crystal cavities. Neither epithelium nor neoplastic or inflammatory cells were observed.