Cavernous hemangioma located at the foramen of Monro: Radiopathological correlation
A 29 year-old female patient presented with non-throbbing intermittent headache for a month before admission. The pain aggravated in the last 2 days. The patient also complained of projectile vomiting in the last 2 days. There was no history of fever, seizures, associated memory disturbance, or altered consciousness. On physical examination, no neurological deficit was found. Magnetic resonance image (MRI) brain revealed a relatively well-delineated lobulated lesion in the anterosuperior aspect of the third ventricular roof, centered in the region of foramen of Monro. On T1-weighted images (T1WI), the lesion was isointense with few small hyperintense hemorrhagic foci within [], and on T2-weighted images (T2WI), the lesion appeared heterogeneous with a peripheral rim of marked hypointensity []. Cystic areas and fluid-fluid levels were seen within the lesion. The lesion showed mild heterogeneous enhancement on post-contrast imaging []. Susceptibility-weighted images revealed marked blooming confirming the hemorrhagic nature of the lesion []. The lesion was causing mass effect in the form of moderate dilatation of bilateral lateral ventricles with periventricular T2W hyperintensities suggesting obstructive hydrocephalus with transependymal ooze. An incidental note was also made of a tubular vascular enhancing structure with branching pattern in the left cerebellum representing developmental venous anomaly [].\nEndoscopic transventricular excision of the vascular malformation and septostomy of septum pellucidum was done. Intraoperatively, the mass was seen to be located in the third ventricle, causing obstruction at the foramen of Monro, and showed xanthochromic appearance. Complete excision of the lesion was done and histological examination revealed mulberry-like cluster of dilated thin-walled capillaries without any intervening neural tissue and surrounding hemosiderin, suggesting cavernous hemangioma [].