J Korean Neurosurg Soc.  2016 Nov;59(6):643-646. 10.3340/jkns.2016.59.6.643.

Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported

• Zeinalizadeh M
• Sadrehosseini SM
• Tayebi Meybodi K
• Sharifabadi AH

• KMID: 2417349
• DOI: http://doi.org/10.3340/jkns.2016.59.6.643

Abstract

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

Keyword

Chordoid glioma; Third ventricle; Suprasellar; Expanded endoscopic transnasal approach

MeSH Terms

Adult
Brain
Eosinophils
Epithelioid Cells
Extracellular Matrix
Female
Glioma*
Headache
Humans
Hypothalamus
Mucins
Optic Chiasm
Optic Nerve
Periodic Acid
Third Ventricle*
Mucins
Periodic Acid

Figure

• 

  Fig. 1 A : Unenhanced axial CT scan reveals an isodense mass in the suprasellar-hypothalamic region. B, C, and D : Axial T1-weighted and sagittal T2-weighted SE MR images show a solid mass in the anterior portion of the third ventricle with non-homogeneous, intense enhancement after contrast injection.

• 

  Fig. 2 Intra-operative image showing tumoral attachment to infundibulum and proximal stalk. White arrow shows the interface between the tumor and wall of the third ventricle. T : tumor, St : stalk, Pit : normal pituitary.

• 

  Fig. 3 A : H&E staining (×20) shows a neoplastic tissue composed of eosinophilic epithelioid cells arranged in small sheets and cords, and in some areas with mucinous extracellular matrix and scattered lymphoplasmacytic infiltrates. B : Extracellular mucinous matrix positivity for PAS-diastase (×40). In immunohistochemistry (×40), tumor cells are diffusely positive for glial fibrillary acidic protein (C), vimentin (D), CD 34 (E), and focally positive for AE1/AE3 (F).

• 

  Fig. 4 Sagittal (A) and coronal (B) T1-weighted gadolinium-enhanced magnetic resonance imaging one month postoperatively showing gross total tumor resection.

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