Incidental intraoperative finding of meningioma in spontaneous acute subdural hematoma: A case report from Saudi Arabia and review of literature.

INTRODUCTION: An association of meningioma with spontaneous acute subdural hematoma has been rarely reported in the literature. Up to date, 38 cases have been reported. PRESENTATION OF CASE: A 74-year-old Saudi female known case of hypertension presented suddenly with dizziness, headache, and left lower limb weakness for 6 h. No history of trauma or anticoagulant medication. Computed tomography scan showed acute subdural hematoma. Pre-operative images were negative for any vascular pathology or lesional tissue. The patient underwent surgery for evacuation of the subdural collection. The presence of abnormal soft tissues within the hematoma was discovered during the surgery and sent for analysis. Histopathological results showed meningothelial subtype grade I meningioma. The patient recovered well, with no obvious neurological deficit or immediate complication. DISCUSSION: Spontaneous acute subdural hematoma without a predisposing factor is a rare occurrence; consequently, a thorough investigation is mandatory in such case to reach the hidden aetiology. CONCLUSION: In this report a rare association of meningioma with an acute subdural hematoma described. Our case was the first one reported where meningioma incidentally discovered during procedure without preoperative suspicion. A small size intracranial lesion may not be detected by preoperative radiological assessment in the presence of a hematoma. Systematic inspection of the operative field is an important surgical step despite negative preoperative radiological images. Our case supports the mechanism of rupture of abnormal vascular structure. More cases needed to understand the mechanism of such a rare association.

Atypical haemorrhagic colloid cyst: 2 case reports surgical management and review of literature.

INTRODUCTION: Colloid cysts are benign cystic lesions located at the anterior part of the third ventricle mostly at the foramen of Monro and contain colloid material. Hemorrhage in a colloid cyst is exceedingly rare. Only 15 clinically diagnosed cases of haemorrhagic cysts were reported in the literature and 5 more cases on autopsy. Here we report two rare cases of a haemorrhagic colloid cyst describing the atypical radiological findings, the undertaken surgical procedures and histopathological results. PRESENTATION OF CASES: We presented 2 cases of haemorrhagic third ventricle colloid cysts. First case is a 27-year-old male patient, presented with dizziness, nausea, vomiting and blurring of vision. He was operated by transcortical endoscopic transventricular excision of a third ventricular cyst and the insertion of external ventricular drain. The second patient is a 21-year-old male, presented with history of worsening headache for 1 month associated with blurring of vision. The patient had a transcortical microscopic, transventricular cyst excision. DISCUSSION: Many questions regarding the best way to diagnose and manage such lesions remain unanswered. Hence, we summarize the relevant diagnostic images and best surgical techniques. CONCLUSION: We concluded that, though exceedingly rare, colloid cyst can bleed and cause rapid deterioration in neurological status, thus, presence of atypical features should alert the physicians to consider atypical colloid cyst that would be valuable in surgical decision making whether endoscopic or microscopic.