Lateral intraventricular epidermoid in a child with hydrocephalus
A 16-year-old male patient was admitted with a 4 month history of moderate intensity, gradually progressive holocranial headache associated with occasional episodes of vomiting. He also had gradually progressive diminution of vision since 4 months in the left eye. There was no other significant history suggestive of any neurological cause. Vision in the right eye was 6/6 and in the left eye was 6/18 with bilateral papilledema. Power in the left UL and LL was 4/5. Apart from this, no neurological deficit was found.\nPre-operative magnetic resonance imaging brain showed a large lobulated, well-defined mass lesion in the atrium and body of the right lateral ventricle, which was hypointense on T1 [] and FLAIR [] sequences and hyperintense on T2 sequences []. The lesion was compressing the 3rd ventricle and was displacing the brainstem caudally []. There was minimal periventricular ooze with obstructive hydrocephalus. Pre-operative presumption of glial cell tumor was considered.\nThe patient underwent right parietal craniotomy and complete removal of lesion. The tumor was pearly white and avascular, occupying the whole of the atrium and body of the right lateral ventricle, and had displaced the septum pellucidum to the opposite side.\nA post-operative contrast computed tomography revealed near-total excision of the lesion and resolution of hydrocephalus. The patient had normal post-operative recovery and his vision in the left eye also improved to 6/12. At follow-up of 6 months, the patient had improvement in his hemiparesis as well.\nHistopathological examination confirmed lesion as epidermoid []; grossly, flakes of pearly white fragmented tissue were submitted for formalin fixation and paraffin sectioning. The H and E, stained slide showed numerous anucleated squamous cells without any presence of identifiable basal germinal cells. No skin adenaxal tissue like sebaceous glands, hair follicles or mucinous gland was identified. The overall features were consistent with epidermoid cyst.