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A 45‐Year Old Man With An Intraventricular Mass

The patient referred to the neurosurgeon in October 2015, complaining polyuria, polydipsia and polyphagia, associated with violent headache, unresponsive to anti-inflammatory therapy, vomit and loss of consciousness. After the onset of visual impairment in the left eye, the patient underwent MRI scan that revealed a giant irregular suprasellar mass (max diam 3.5 cm) moving from the level of the infundibular area within the third ventricle chamber; these lesion showed (Figure 1A) strong and in-homogenous enhancement post-GAD and little calcified spots were noted within its bulk. Pituitary hormonal levels were within the normal range. In May 2016 the patient underwent surgery, by mean of endoscopic endonasal approach: at this time, due to the hard consistency, the tight adherences of the tumor and the narrow and deep corridor lesion has been only partially removed. As per protocol a second transcranial approach was scheduled, nevertheless three months later, hydrocephalus developed and urgent ventricleperitoneal shunt procedure was required, although residual tumor was stable. Six months thereafter a new MRI disclosed a slight enlargement of tumor (volume increase was 30% more than the prior exam), so that transcranial transcorticaltransventricular approach was adopted to remove the lesion. Extent of removal at that time was near-total (>90%), nevertheless, patient died few weeks later due to severe meningitis that complicated with multi-organ failure. PATHOLOGICAL FINDINGS