A 30-year-old male presented with complaints of holocranial headache with transient episodes of blurring of vision for 1 month. His neurological examination was normal. Fundoscopy revealed bilateral florid papilledema.\nHe was investigated with MRI brain, which revealed a hyperintense (T1W and T2W) solid cystic lesion measuring 3 × 2.9 × 3 cm3 in the anterior third ventricle causing hydrocephalus with enhancement on contrast imaging. The solid portion was hypointense on T2W images and was nonenhancing on T1W-Gadolinium contrast images [Figure -]. The imaging differential diagnosis was colloid cyst with inspissated protein contents or craniopharyngioma.\nThe patient underwent right frontal craniotomy, and the lesion was approached through interhemispheric transcallosal interforniceal route as the lesion was large and would have been difficult to excise from transforaminal variation of the transcallosal approach. The lesion was solid cystic located in the third ventricle near the foramen of Monro and contained about 2-3 mL of machine oil like fluid which was drained. The solid part of the lesion was avascular, firm, and grayish black in color which was excised. The capsule was removed completely except for the part which was densely adherent to the floor of the third ventricle. An Ommaya reservoir was kept in the third ventricle for external ventricular drainage []. The external drain was removed on postoperative day 5, and a CT scan was repeated on day 7 to look for the residual blood in the ventricles. There was dilatation of the ventricles with periventricular lucency for which a right ventriculo-peritoneal shunt was performed. There was no residual tumor left in the third ventricle.\nHistopathological examination of excised specimen revealed all the typical diagnostic features of a colloid cyst except for certain parts of the cyst wall where the simple, compressed, ciliated, cuboidal lining lacked a brush border and was sometimes entirely missing. Moreover, the cyst wall was multilayered and thickened by granulomatous tissue which was composed of a potpourri of cells. There was a predominance of epithelioid cells and macrophages, many of which contained refractile material and hemosiderin. Polymorphonuclear leukocytes were diffusely scattered throughout the granuloma, and lymphocytes were seen in focal collections. Foreign body giant cells were not a conspicuous feature. Cholesterol clefts were also noted [Figure -].\nThe patient is under regular follow-up and doing well with no fresh neurological deficits at end of 1 year.
We present a case of a 36-year-old male who was admitted to the hospital due to a 1-month history of daily headaches within the occipital region. The headaches were reported to be worse at night and occasionally accompanied by nausea and dizziness. Neurological examinations revealed a right-sided exaggerated tendon reflex compared to the contralateral side. The patient was diagnosed with a positive pyramidal syndrome, Hoffmann’s reflex, and Babinski’s and Rossolimo’s sign on the right side. A CT scan revealed a 20 × 15 × 23 mm isodense focal lesion in the posterior fossa at the level of the foramen magnum []. The lesion extended to the level of the dens of axis while compressing the spinal cord posteriorly. Proton density [], T1 [ and ], and T2 [ and ] weighted MRI scans revealed a 22 × 11 × 33 mm well-defined cystic mass with two heterogeneous compartments within the foramen magnum at the level of C1-2. The medulla and spinal cord were shown to be displaced and compressed along with remodeling of the vertebral arteries with the right artery mainly affected. The superior half of the lesion was hyperintense on T2WI [] and moderately hypointense on T1WI MRI []. The inferior half of the lesion was hypointense on T2WI and hyperintense on T1WI MRI. No enhancement was shown after contrast administration. After careful consideration, the far lateral approach was chosen, and the patient underwent preparation for the procedure. A J-shaped skin incision followed by a suboccipital craniotomy, C1 laminectomy, and a C2 hemilaminectomy was performed. The dura was opened, exposing the extramedullary cyst. Complete resection (CR) was achieved and a cranioplasty with a typical closure concluded the operation. A histological examination revealed the cyst to be most consistent with a type B NC. The postoperative course was uneventful, and the patient was discharged on the 7th day without any neurological deficits. In a later follow-up, a CT scan revealed no sign of cyst recurrence.