Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported

Abstract

Chordoid glioma of the third ventricle is a rare and challenging tumor to surgery because of its unique anatomical location and its close juxtaposition to the neurovascular structures and hypothalamus. The authors report a case of chordoid glioma of the third ventricle in a 43-year-old woman, who presented with headache and somnolence. The tumor was approached by endoscopic transnasal technique with a favorable result. Histopathologic examination disclosed a neoplastic tissue composed of eosinophilic epithelioid cells, mucinous, periodic acid Schiff-diastase positive, extracellular matrix, and scattered lymphoplasmacytic infiltrates. The best treatment option remains controversial. Customarily, the surgical route to remove chordoid glioma is transcranial; however, the undersurface of the optic chiasm and optic nerves preclude an adequate surgical visualization. In contrast, an expanded endoscopic transnasal approach provides a direct midline corridor to this region without any brain retraction.

Transphenoidal Surgery : The Optimal Approach to Chordoid Gliomas of the Third Ventricle?

“…The pathological features of the lesion were consistent with the diagnosis of CG. Following surgery, visual symptoms persisted and the patient developed panhypopituitarism, diabetes insipidus and somnolence, a clinical picture quite similar to that observed in the patient described in the article by Zeinalizadeh et al [ 5 ]. In the latter report, however, no detailed information concerning the evolution of the patient’s visual symptoms nor the account of his long-term follow-up clinical data are provided.…”

“…We have read in detail the interesting article entitled, “ Expanded Endoscopic Transnasal Approach to the Chordoid Glioma of the Third Ventricle : The First Case Ever Reported ”, published in 2016 in the Journal of the Korean Neurosurgical Society [ 5 ]. Some years ago, we were involved in the treatment of a case of chordoid glioma (CG) of the third ventricle and became highly interested in the study of this very rare kind of tumor [ 1 ].…”

Occurrence of Chordoid Glioma With Sodium Ion Metabolism Disorder 5 Years After Meningioma Surgery and Whole-Exome Sequencing: A Case Report and Literature Review

“…Retrospective findings of trans-lamina terminalis may be associated with lower rates of post-operative mortality and complications compared with other approaches; however, there is limited data to support this hypothesis (Liu et al, 2011 ; Ki et al, 2016 ; Carrasco-Moro et al, 2018 ). In 2016, a CG patient with vision and visual field changes underwent surgery through the expanded objective transnasal approach for complete removal of the tumor (Zeinalizadeh et al, 2016 ). Compared with the transcrania approach, the endoscopic transnasal approach can provide excellent visualization of the undersurface of the optic chiasm and optic nerves.…”

Usefulness of neuroimaging and immunohistochemical study for accurate diagnosis of chordoid glioma of the third ventricle: A case report and review of the literature

“…This tumor is currently recognized as a distinct glioma with grade II malignancy. [ 2 3 9 12 13 14 19 20 ] In previous reports, chordoid glioma has been described as tending to occur in middle-aged and older adults (25–75 years). [ 8 15 ] The clinical symptoms of this tumor are variable, according to tumor size and location.…”

“…[ 3 ] This tumor was initially considered a variant of meningioma, but was subsequently accepted as a distinct glioma and classified as grade II according to the 2016 World Health Organization (WHO) classification of brain tumors. [ 2 3 9 12 13 14 19 20 ] Due to its rarity, the definitive features of the clinical course, treatment strategy, and prognosis have not been elucidated. [ 3 8 13 ] Therefore, it is necessary for recognizing the characteristic features of this tumor, including neuroimaging, pathological findings, and risks of surgical procedures.…”