Authors: Almohannad S Algarni , Saud S Alasmari , Abdulaziz S Alqahtani , Turki D Alshammari , Abdu M Alkhairi

Abstract

Background: Pilocytic astrocytomas (PA) are low-grade, benign gliomas classified as WHO grade I, representing 6% of all gliomas and commonly found in children. Intraventricular pilocytic astrocytomas (IVPA) are rare, accounting for only 4% of PA cases.

Case Presentation: We report a 42-year-old Saudi woman with recurrent positional headaches but no neurological deficits. MRI showed a 1.2-cm non-enhancing lesion near the foramen of Monro, initially thought to be a colloid cyst. The lesion was excised via an interhemispheric transcallosal approach. Histopathology confirmed PA with biphasic tissue, glomeruloid vessels, and strong GFAP positivity, classified as WHO grade I. No further chemotherapy or radiotherapy was required.

Postoperative Outcome: Post-surgery, the patient had transient short-term memory issues, partially resolving within six months, and her headaches ceased. Initial imaging showed pneumocephalus, which resolved after one month.

Discussion: IVPA typically remain asymptomatic until they cause hydrocephalus by obstructing cerebrospinal fluid pathways. Radiologically, they appear as well-defined lesions with mixed cystic and solid components. Complete surgical resection is crucial to minimize recurrence.

Conclusion: IVPA, though rare in adults, should be considered in the differential diagnosis of intraventricular lesions. This case highlights the significance of accurate diagnosis and surgical management for this uncommon tumor.

Keywords: Pilocytic astrocytoma, intraventricular tumor, neurosurgery, case report, Adult glioma.