Intraventricular Cavernous Hemangioma of the Lateral Ventricle

Intraventricular cavernous h emangioma is a rare lesion. Dandy 1 reported his series of 5 cases of cavernous angiomas of the brain and ieviewed 44 cases in the literature. In none of these cases was the lesion located inside the lateral ventricles. Dandy 2 later reported 13 benign encapsulated tumours of the lateral ventricles, none of which was a cavernous hemangioma. Schneider and Liss 3 presented 3 cases of well encapsulated cavernous hemangioma of the brain but in only 1 of these cases was the tumor located inside the right lateral ventricle. The rarity of this condition and some unusual features of this case have prompted this report. Case Report C.P., a 15-year-old Italian boy, was first seen on May 17th, 1965, with a complaint of headaches for the last one and a half months. There was no definite episode at the onset of these headaches. They were throbbing in character and usually started in the left temporal region and radiated to the occiput. Recently the headaches had become more generalized. The boy was born in Italy and at the age of 6 years had an episode of headache which subsided spontaneously. No investigations were done at that time. There was no evidence that he had suffered Received for publication August 5, 1965. Revision received November ~, 1965. from tuberculosis, syphilis, toxoplasmosis or hydatid disease. After the age of 6 years he emigrated to Canada and had no illness until the present episode of headaches. Examination. The patient was well built and well nourished, conscious and well oriented. There was no deficit of higher cerebral functions. Fundoscopic examination revealed bilateral early papilledema. The rest of the neurological examination was normal. Radiology. Plain x-rays of the skull revealed an area of ringlike calcification in the left parietal region (Fig. 1). An electroencephalogram indicated paroxysmal disorder of deep midline origin with right sided voltage preponderance. Bilateral carotid angiography (Fig. ~) showed shift of the anterior cerebral artery from right to left. There were no abnormal vessels in the region of calcification in tile left parietal region. There was no tumor stain in the right hemisphere. Pneumoencephalography (Fig. 3) showed a large intraventricular mass in the anterior portion of the right lateral ventricle. There was slight enlargement of the ventricular system with shift of the septum pellucidum from right to left. Cerebrospinal fluid had a protein content of 64 mg. per cent with 7,000 red blood cells per c. ram. Glucose was 54 mg. per cent and chloride 67 mg. per cent. Examination of eerebrospinal fluid for tumor cells was negative. Various tests for tuberculosis, syphilis and hydatid disease were negative. Operation. On May ~0, 1965, a right frontal craniotomy was done and through an incision in the right premotor area an encapsulated cystic nmss in the right