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CASE REPORT
Year : 2007  |  Volume : 2  |  Issue : 1  |  Page : 20-22
 

Intraventricular hydatid cyst causing entrapped temporal horn syndrome: A case report and review of literature


Dept. of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

Correspondence Address:
P Maurya
c/o Dr. Vivek Sharma, Head, Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi - 221 005
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1817-1745.32002

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   Abstract 

Entrapped temporal horn is due to obstruction of one lateral ventricle in the region of trigone. The isolated temporal horn presents itself as a mass lesion. Intraventricular hydatid cyst presenting as an entrapped temporal horn has not been reported in literature till date. We report a case of intraventricular hydatid cyst causing entrapped right temporal horn in a 25-year-old female.


Keywords: Entrapped ventricle, foramen of monro, hydatid cyst, hydrocephalus, neonatal meningitis


How to cite this article:
Maurya P, Singh V P, Prasad R, Bhaikhel K S, Sharma V, Kumar M. Intraventricular hydatid cyst causing entrapped temporal horn syndrome: A case report and review of literature. J Pediatr Neurosci 2007;2:20-2

How to cite this URL:
Maurya P, Singh V P, Prasad R, Bhaikhel K S, Sharma V, Kumar M. Intraventricular hydatid cyst causing entrapped temporal horn syndrome: A case report and review of literature. J Pediatr Neurosci [serial online] 2007 [cited 2019 Aug 23];2:20-2. Available from: http://www.pediatricneurosciences.com/text.asp?2007/2/1/20/32002



   Introduction Top


Entrapment of temporal horn is a rare entity. It is due to an obstruction of the trigone of the lateral ventricle, which seals off the temporal horn from the rest of the ventricular system. [1],[2] Continued secretion of cerebrospinal fluid (CSF) by choroid plexus within the temporal horn leads to progressive dilatation of temporal horn and is presented as space occupying lesion. Intraventricular hydatid cyst has been rarely reported in literature; [3] its causing of entrapped temporal horn has not been reported till date. We are reporting a case of entrapped temporal horn due to hydatid cyst presented as a space occupying lesion in a 25-year-old female.


   Case Report Top


History

A 25-year-old female was presented with complex partial seizures for 3 months. She had bifrontal headache for the last 2 months, which was moderate in intensity and aggravated in the early morning hours. Headache was often associated with vomiting. The patient had no focal neurological deficit except for bilateral early papilledema. Enhanced CT scan of head showed a right temporal cystic mass with perilesional edema and enhancement with contrast. The cyst had attenuation value of 7 hounse field unit [Figure - 1].

Operation

The left temporal horn was approached through a left temporal craniotomy, and a well-defined whitish cyst of 2.5 cm × 2 cm size present at trigone was removed in toto without rupture [Figure - 2].

Histopathological examination

Microscopically the typical laminated cyst wall could be seen, and the compressed surrounding tissue showed mononuclear inflammatory cell infiltrates. Diagnosis of hydatid cyst was confirmed [Figure - 3].

Postoperative course

Postoperative period was uneventful. Follow-up checkup showed complete recovery in headache and papilledema. There was no evidence of other cyst on X-ray chest and ultrasound abdomen.


   Discussion Top


Hydrocephalus results when the flow of CSF is impeded. When the block lies within the ventricular system, it is termed "obstructive hydrocephalus." Both active secretion of CSF by the choroid plexus and pulse waves from the plexus expand the trapped part of the ventricular system. [1],[4],[5],[12] Brain parenchyma has only a limited capacity to absorb CSF. If part of the ventricular system is closed off from the rest and if the sealed-off section contains choroid plexus, a partial or focal hydrocephalus may result. It may develop under two circumstances. First, obstruction of one foramen of Monro may cause hydrocephalus confined to one lateral ventricle. [1],[6] This so-called unilateral hydrocephalus leads to symptoms of raised intracranial pressure. It may be due to lesion in the region of the foramen of Monro-colloid cyst of third ventricle, tumor of the septum pellucidum and thalamus, congenital gliotic atresia of foramen of Monro and after ventriculitis or surgical procedure within lateral ventricle. [6],[7],[8],[9] Second condition wherein partial hydrocephalus may occur is after meningitis in infancy. [1],[10]

Entrapment of temporal horn was first termed by Maurice-Williams et al . [1] to describe a form of focal hydrocephalus. He described three cases of a syndrome in which obstruction of the trigone of the lateral ventricle sealed off the temporal horn from the rest of the ventricular system. A temporal horn contains choroid plexus, and cerebrospinal fluid secreted by these choroid plexus leads it to expand into a cyst. This gives rise to the symptoms of raised intracranial pressure as well as appropriate features of focal cerebral dysfunction such as a dysphasia or a contralateral hemiparesis.

Tsugane et al . [11] reported two cases of entrapment of temporal horn due to intraventricular block of CSF flow as a consequence of choroids plexitis resulting in obstruction of the CSF pathway at atrium. External drainage followed by shunt emplacement was done, and the patient improved.

Watanabe et al . [2] reviewed eight cases including his one case which was due to intraventricular hemorrhage caused by rupture of a large left parasplenial arteriovenous malformation. He successfully treated the case by ventriculoteritoneal shunt.

Intraventricular hydatid cyst is rarely reported. Evliyaoglu, Keskil [3] reported a case of a 7-year-old girl who had a free-floating, intraventricular hydatid cyst, diagnosed by computerized tomography examination inside the enlarged left lateral ventricle of an associated Dandy Walker malformation. The patient underwent surgery and the cyst was removed.

We have herein reported a case of entrapment of temporal horn due to hydatid cyst which has not been reported in literature till date. Entrapment of temporal horn due to hydatid cyst may be suspected in patients who develop symptoms of an expanding temporal lobe mass with or without a primary lesion, particularly in endemic area, and a high index of suspicion is a must to diagnose it. Surgical excision without rupture of the cyst is the treatment of choice.

 
   References Top

1.Maurice-Williams RS, Chokesy M. Entrapment of the temporal horn: A form of focal obstructive hydrocephalus. J Neurol Neurosurg Psychiatry 1986;49:238-42.  Back to cited text no. 1    
2.Watanabe T, Katayama Y. Evaluation by magnetic resonance imaging of the entrapped temporal horn syndrome. J Neurol Neurosurg Psychiatry 1999;66:113.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Evliyaoglu C, Keskil S. Possible spontaneous "birth" of a hydatid cyst into the lateral ventricle. Childs Nerv Syst 2005;21:425-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Linder M, Diehl JT, Sklar FH. Significance of post shunt ventricular asymmetries. J Neurosurg 1981;55:183-6.  Back to cited text no. 4  [PUBMED]  
5.Pattorossi DI, Di Rocco C, Mancinelli R, Caldarelli M, Velardi F. Communicating hydrocephalus induced by mechanically increased amplitude of the intraventricular cerebrospinal fluid pulse pressure: Rationale and method. Exp Neurol 1978;59:30-9.  Back to cited text no. 5    
6.Wilberger JE Jr, Vertosick FT Jr, Vries JK. Unilateral hydrocephalus secondary to congenital atresia of the foramen of Monro. J Neurosurg 1983;59:899-901.  Back to cited text no. 6  [PUBMED]  
7.Bhagwati S. A case of unilateral hydrocephalus secondary to occlusion of one Foramen of Monro. J Neurosurg 1964;21:226-9.  Back to cited text no. 7  [PUBMED]  
8.Black PM, Levine BW, Picard EH, Nirmal K. Asymmetrical hydrocephalus following ventriculitis from rupture of a thalamic abscess. Surg Neurol 1983;19:524-7.  Back to cited text no. 8    
9.Milhorat TH, Hammock MK, Breckhill DL. Acute unilateral hydrocephalus resulting from oedematous occlusion of foramen of Monro: Complication of intraventricular surgery. J Neurol Neurosurg Psychiatry 1975;38:745-8.  Back to cited text no. 9    
10.Kalsbeck JE, De Sousa AL, Kleiman MB, Goodman JM, Frankman EA. Compartmentalization of the cerebral ventricles as a sequel of neonatal meningitis. J Neurosurg 1980;52:547-52.  Back to cited text no. 10    
11.Tsugane R, Shimoda M, Yamaguchi T, Yamamoto I, Sato O. Entrapment of the temporal horn: A form of focal non-communicating hydrocephalus caused by intraventricular block of cerebrospinal fluid - report of two cases. Neurol Med Chir (Tokyo) 1992;32:210-4.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]
12.McComb JG. Recent research into the nature of cerebrospinal fluid formation and absorption. J Neurosurg1983;59:369-83.  Back to cited text no. 12  [PUBMED]  


    Figures

  [Figure - 1], [Figure - 2], [Figure - 3]


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