Primary Suprasellar Hypothalamic CNS Lymphoma in an Immunocompetent Adult: A Case Report and Review of Literature.

BACKGROUND: Primary suprasellar central nervous system lymphoma (PCNSL) of the hypothalamus is a rare entity. MATERIAL AND METHODS: We report a case of a 49-year-old, healthy male presented with features of diabetes insipidus. Imaging features showed a mass in the suprasellar region involving the hypothalamus mainly tuber cinereum and infundibulum. RESULTS: Preoperative fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) showed increased uptake in the mass. Biopsy revealed a diffuse type-B PCNSL. The present case emphasizes the importance of considering the diagnosis of hypothalamic lymphoma and the utility of FDG PET-CT in such situations. CONCLUSION: To our knowledge, only eight cases of suprasellar hypothalamic PCNSL have been reported in the literature.

Role of Secondary Endoscopic Third Ventriculostomy in Children: Review of an Institutional Experience.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has become a standard and safe procedure for obstructive hydrocephalus. ETV can also play an important role in children presenting with shunt malfunction with an added advantage of shunt independence. Secondary ETV can be defined as either a redo endoscopic ventriculostomy done after primary ETV stoma closure or that done in cases presenting with shunt malfunction. OBJECTIVE: The aim of our study was to evaluate the role of secondary ETV in the pediatric age group patients. METHODS: This is a retrospective analysis of 36 children (<18 years) who underwent ETV after shunt malfunction and 4 children with ETV done after previous ETV stoma closure from 2004 until 2018. In all patients, the obstructive pattern suggesting aqueduct outflow obstruction was observed on MRI. Patients were followed up for a mean period of 4.25 years. RESULTS: ETV was considered successful if the patient avoided a shunt insertion later on in their life. Considering this definition, a success rate of 72% was observed with secondary ETV for shunt malfunction whereas a success rate of 75% was observed after primary ETV failure without any major side effects in any of the patients. CONCLUSION: ETV can be considered a primary treatment modality in children with shunt malfunction and has a good success rate in cases presenting with closure of previously performed ETV stoma.

Primary intraventricular meningiomas in children-experience of two cases with review of literature.

Meningiomas are rare in the pediatric age group, more so in the intraventricular location. They arise in the lateral ventricles from the arachnoid cells contained within the choroid plexus, in the third ventricle from the velum interpositum and in the fourth ventricle from the choroids. These tumors are usually large and have an aggressive behaviour. Surgical management of intra-ventricular meningiomas is challenging because of their deep location, large size at presentation and increased vascularity. The authors report two such cases who presented with symptoms of raised intra cranial pressure and on evaluation were found to have associated hydrocephalus. Both these patients underwent surgical excision of the tumour by frontal transcortical approach and histopathology report confirmed transitional meningioma in them. Only twenty seven cases of intraventricular meningiomas in children have been reported till date. Their definitive treatment is surgery alone and total excision of the tumor is curative. Possibility of neurofibromatosis as a differential should also be considered in their management.