Mitani Koki, Tanji Masahiro, Kitada Yuji, Kikuchi Masahiro, Sugimoto Akihiko, Fujimoto Masakazu, Arakawa Yoshiki
Departments of Neurosurgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Departments of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
J Neurosurg Case Lessons. 2024 Sep 16;8(12). doi: 10.3171/CASE2460.
Chondrosarcoma is typically a slow-growing tumor, and intratumoral hemorrhage is rare. Acute brainstem hemorrhage due to chondrosarcoma has rarely been reported.
A 77-year-old man presented with the sudden onset of headache and vomiting followed by a declining level of consciousness, progressive right hemiparesis, and left ophthalmoplegia. Magnetic resonance imaging showed pontine hemorrhage and a mass in the retroclival space compressing the brainstem. Emergency endoscopic endonasal surgery was performed. Intraoperative observation revealed that a hematoma was located in the pons and subdural space around the tumor mass, suggesting that the hematoma had likely been caused by the rupture of small vessels around the pons, not by intratumoral hemorrhage. The pathological diagnosis was chondrosarcoma. The patient recovered well and underwent radiotherapy.
This report describes a case of sudden neurological deterioration due to hemorrhage in a patient with chondrosarcoma of the skull base. An emergency endoscopic endonasal approach for mass reduction and hematoma removal was effective in the acute setting. This approach revealed the suspected etiology of peritumoral hemorrhage, not intratumoral hemorrhage. https://thejns.org/doi/10.3171/CASE2460.
软骨肉瘤通常是一种生长缓慢的肿瘤，瘤内出血罕见。软骨肉瘤导致急性脑干出血的情况鲜有报道。
一名77岁男性突发头痛、呕吐，随后意识水平下降，出现进行性右侧偏瘫和左侧动眼神经麻痹。磁共振成像显示脑桥出血以及斜坡后间隙有一肿块压迫脑干。遂行急诊内镜下经鼻手术。术中观察发现血肿位于脑桥及肿瘤周围的硬膜下间隙，提示血肿可能是由脑桥周围小血管破裂所致，而非瘤内出血。病理诊断为软骨肉瘤。患者恢复良好并接受了放疗。
本报告描述了一例因颅底软骨肉瘤出血导致突发神经功能恶化的病例。在急性情况下，急诊内镜下经鼻入路进行肿块减压和血肿清除是有效的。该方法揭示了肿瘤周围出血而非瘤内出血的疑似病因。https://thejns.org/doi/10.3171/CASE2460
