A 20-year-old lady presented with a 6 months history of progressive headache and memory disturbances. Few days prior to presentation, she had three episodes of generalized tonic clonic seizures. She also had gait disturbances and severe giddiness. Higher mental function examination revealed impaired recent memory. Fundoscopic examination showed bilateral papilloedema. Cranial nerve examination, motor and sensory examination was normal. Plantar reflexes were extensor on both sides and Romberg's sign was positive. Computed tomography (CT) scan of the brain showed isodense lesion located at foramen of Monro with hyperdense areas suggestive of hemorrhage with foraminal obstruction. The lesion was not enhancing on contrast []. Magnetic resonance imaging (MRI) brain revealed obstructive hydrocephalus due to a large lesion in the third ventricle which was homogenously hyperintense on T1-weighted images and homogenously hypointense on T2-weighted images [].\nRight lateral ventricle was entered via right frontoparietal craniotomy and an interhemispheric transcallosal approach. A grayish red, well-defined, soft to firm lesion was reached through the interforniceal approach. Needle aspiration was attempted but was unsuccessful. The surface of the cyst was vascular, so it was coagulated. The cyst wall was thickened and its separation from surrounding tissue was difficult. On opening the cyst, there was no colloid material, but a brownish yellow organized clot was found which was removed piecemeal. The clot was easily separated from the inner cyst wall. After almost complete evacuation of cyst content, the thick wall was held with biopsy forceps with one hand and with the other hand it was dissected from the surrounding parenchymal tissue. A complete excision of the cyst was ensured. Both internal cerebral veins were seen and found intact. Pathological examination confirmed hemorrhage within the colloid cyst. Microscopic examination also showed blood clots containing hemosiderin laden macrophages and many rhomboid cholesterol crystals and chronic inflammatory cells []. Post-operatively she had no seizures. Her memory function completely improved over a 3 week period.
A 47-year-old man, with a history of primary systemic hypertension and anxiety disorder with agoraphobia, was admitted in our department with acute-onset speech impediment and loss of strength in the right side of his body, accompanied by headache, vomiting, and deterioration of his level of consciousness. A Glasgow Coma Scale (GCS) score of 8 [E2, V2, M4 (E: Eye response, V: Verbal response; M: Motor response)] and a right-sided hemiplegia were noted during his initial assessment in the emergency room. His arterial blood pressure was found to be 210–140 mmHg. Acute obstructive hydrocephalus due to a rounded hyperdense mass within the third ventricle was revealed on the emergency brain computed tomography (CT), in addition to a moderate size acute hematoma in the left basal ganglia [Figure and ]. The immediate placement of an external ventricular drainage in the frontal horn of the right ventricle allowed controlled evacuation of blood-stained CSF and alleviation of intracranial hypertension (initial value of 32 mmHg). After clinically stabilizing the patient, a presumed diagnosis of a colloid cyst within the third ventricle was made by magnetic resonance imaging (MRI) []. The tumoral lesion was completely removed 2 days later through a right far lateral interhemispheric transcallosal approach.[] Pathological analysis of the lesion confirmed the diagnosis of a colloid cyst with vascular congestion and foci of acute bleeding within its wall []. The patient developed postoperative bifrontal pneumocephalus that spontaneously resolved itself over a period of several days. Once the CSF pathways’ permeability was restored, the ventricular drain was removed with favorable evolution. Follow-up MRI study confirmed total resection of the lesion []. Right-sided hemiparesis (3/5) with impaired propioception and a mixed type sensitive and motor disphasia persisted at the latest follow-up assessment 1 year after surgery. Neuropsychological assesment revealed bradipsychia, anosognosia, as well as attention, concentration, and working memory significant deficits.