A 46-year-old female presented with an intracranial hypoglossal neurinoma manifesting only as spastic ity in the lower extremities without hypoglossal nerve paresis. Magnetic resonance imaging greatly aid ed in the early detection of the tumor with this atypical presentation.Unilateral suboccipital craniotomy with resection of the occipital condyle allowed us to approach the tumor in front of the medulla from an inferolateral direction and to remove it successfully. We emphasize the need to pack dead space with fatty tissue to prevent cerebrospinal fluid leakage.
A 46-year-old male presented with acute visual loss in the right eye, high fever, nausea, and vomiting. This was caused by herniation of the third ventricle into empty sella at 15 months of surgery for pituitary apoplexy. The sellar-suprasellar tumor was totally removed via a transcranial approach. Histological examination showed chromophobe adenoma with necrotic tissue, indicating pituitary apoplexy. His visual field defect worsened 15 months after the operation, and magnetic resonance imaging revealed moderate hydrocephalus and protrusion of the dilated anterior inferior portion of the third ventricle into the sella. The optic nerve, optic chiasm, and pituitary gland were compressed onto the sellar floor. Ventriculoperitoneal shunt relieved the visual impairment. A decompressive procedure such as ventriculoperitoneal shunts is a reasonable treatment for such a marked herniation of the third ventricle.
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