Case 10: 4th ventricular mass

posted: October 27, 1996

Residents: Ian Angel, MD and John Ratliff MD
Attending: Deepak Awasthi, MD

CLINICAL PRESENTATION: This 43 white woman presented to the neurosurgery clinic with a 2 month history of progressively worsening headache as well as mild difficulty walking. No other deficits were described. Pt had no significant past medical history. Her examination on presentation showed her to be awake and alert. She had good motor strength throughout with good tone. No sensory deficits. Romberg sign negative. No pathological reflexes. No dysmetria. Gait was mildy ataxic. All the cranial nerves were intact except for a mild right peripheral seventh nerve paresis.

DIAGNOSTIC STUDIES: Her diagnostic studies included a cranial CT scan followed by a MRI scan of brain with and without contrast. A representative non-contrast study is shown below:

Note the hyperintense lesion in the 4th ventricle

What is you differential diagnosis?

Please comment: dawast@lsuhsc.edu

STEPS TAKEN AT LSU: Patient was taken to the OR and through a midline posterior fossa craniectomy (prone position), the vermis was split and the 4th ventricle entered- a soft yellowish mass was found adherent to the floor of the ventricle. The mass was easily dissected from the floor and grossly resected. A representative intraoperative photograph is shown below:

T: tumor; IV vent: fourth ventricle floor

POSTOPERATIVE COURSE: Postoperative, the patient was awake/ alert. However, she did have an increase in her right peripheral seventh paresis and an accompanying mild right 6th nerve paresis.

PATHOLOGY: Lipoma

We are currently doing a literature search on this rare occurence of a 4th ventricular lipoma. STAY TUNED

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