Abstract
This chapter covers tumors that affect the third ventricle, including meningioma, colloid cyst, chordoid glioma, choroid plexus papilloma, hamartomas of the tuber cinereum, ependymomas, central neurocytoma, and subependymoma.
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Keywords
- Third ventricle meningioma
- Third ventricle colloid cyst
- Third ventricle ependymomas
- Central neurocytoma
- Choroid plexus papilloma
-
1.
Third ventricle tumor epidemiology, the FALSE answer is:
-
A.
Third ventricle tumors account for less than 1% of all brain tumors.
-
B.
A colloid cyst is the most common lesion in children.
-
C.
A colloid cyst occurs most commonly in the third ventricle of adults.
-
D.
A colloid cyst is most commonly located in the anterior part of the third ventricle.
-
E.
Ependymomas are the third most common primary third ventricular tumor found in children.
Third ventricle tumor epidemiology, the FALSE answer is:
-
A.
Third ventricle tumors account for less than 1% of all brain tumors.
-
B.
A colloid cyst is the most common lesion in children.
-
C.
A colloid cyst occurs most commonly in the third ventricle of adults.
-
D.
A colloid cyst is most commonly located in the anterior part of the third ventricle.
-
E.
Ependymomas are the third most common primary third ventricular tumor found in children.
Answer B
-
The most common intraventricular tumors in children are choroid plexus papillomas.
-
2.
Third ventricle tumor epidemiology, the FALSE answer is:
-
A.
The most common true mass of the foramen of Monro in adults is a colloid cyst.
-
B.
The most common pediatric lesion of the foramen of Monro is the subependymal giant cell tumor.
-
C.
The subependymal giant cell tumor (WHO grade I) appears as a heterogeneously enhancing mass.
-
D.
The subependymal giant cell tumor is associated with Sturge Weber syndrome.
-
E.
The most frequent third ventricle floor lesion is the tuber cinereum hamartoma.
Third ventricle tumor epidemiology, the FALSE answer is:
-
A.
The most common true mass of the foramen of Monro in adults is a colloid cyst.
-
B.
The most common pediatric lesion of the foramen of Monro is the subependymal giant cell tumor.
-
C.
The subependymal giant cell tumor (WHO grade I) appears as a heterogeneously enhancing mass.
-
D.
The subependymal giant cell tumor is associated with Sturge Weber syndrome.
-
E.
The most frequent third ventricle floor lesion is the tuber cinereum hamartoma.
Answer D
-
Subependymal giant cell tumor (WHO grade I) is associated with tuberous sclerosis.
-
3.
Third ventricle meningioma, the FALSE answer is:
-
A.
Embryological origin can be from arachnoid cap cells.
-
B.
Embryological origin can be from ependymal lining cells.
-
C.
It typically has homogenous contrast enhancement on MRI.
-
D.
The most common location is the anterior third ventricle.
-
E.
Peak incidence is in the second decade.
Third ventricle meningioma, the FALSE answer is:
-
A.
Embryological origin can be from arachnoid cap cells.
-
B.
Embryological origin can be from ependymal lining cells.
-
C.
It typically has homogenous contrast enhancement on MRI.
-
D.
The most common location is the anterior third ventricle.
-
E.
Peak incidence is in the second decade.
Answer D
-
The majority of third ventricular meningiomas are located posteriorly in the pineal region.
-
4.
Third ventricle meningioma, the FALSE answer:
-
A.
Commonly misdiagnosed as colloid cyst.
-
B.
The majority are psammomatous meningioma.
-
C.
Third ventricular meningiomas are more common in males.
-
D.
In von Recklinghausen’s disease, the incidence of intraventricular meningiomas is 16.6%.
-
E.
Blood supply is from the medial posterior choroidal arteries.
Third ventricle meningioma, the FALSE answer:
-
A.
Commonly misdiagnosed as colloid cyst.
-
B.
The majority are psammomatous meningioma.
-
C.
Third ventricular meningiomas are more common in males.
-
D.
In von Recklinghausen’s disease, the incidence of intraventricular meningiomas is 16.6%.
-
E.
Blood supply is from the medial posterior choroidal arteries.
Answer B
-
The majority of third ventricle meningiomas are fibroblastic, syncytial, or of mixed type.
-
5.
Third ventricle colloid cyst, the FALSE answer is:
-
A.
Appear hyperdense on CT.
-
B.
Are most commonly found near the foramen of Monro.
-
C.
The cysts are lined with stratified squamous epithelial cells.
-
D.
Can cause sudden death due to hypothalamic compression.
-
E.
The most common presenting symptom is headache.
Third ventricle colloid cyst, the FALSE answer is:
-
A.
Appear hyperdense on CT.
-
B.
Are most commonly found near the foramen of Monro.
-
C.
The cysts are lined with stratified squamous epithelial cells.
-
D.
Can cause sudden death due to hypothalamic compression.
-
E.
The most common presenting symptom is headache.
Answer C
-
Colloid cyst is lined with an inner layer of cuboidal or cylindrical cells and an outer layer of connective tissue including vessels.
-
6.
Third ventricle colloid cyst, the FALSE answer is:
-
A.
It originates from the folding of the primitive neuroepithelium.
-
B.
Shows homogenous enhancement on T1MRI with gadolinium.
-
C.
Contents of the cysts include old blood, foamy cells, fat, cholesterol crystals, and CSF.
-
D.
Colloid cysts have varied appearances on MR images.
-
E.
CT evidence of calcification in a colloid cyst is uncommon.
Third ventricle colloid cyst, the FALSE answer is:
-
A.
It originates from the folding of the primitive neuroepithelium.
-
B.
Shows homogenous enhancement on T1MRI with gadolinium.
-
C.
Contents of the cysts include old blood, foamy cells, fat, cholesterol crystals, and CSF.
-
D.
Colloid cysts have varied appearances on MR images.
-
E.
CT evidence of calcification in a colloid cyst is uncommon.
Answer B
-
Colloid cyst shows peripheral enhancement on T1MRI with gadolinium.
-
7.
Third ventricle arachnoid cyst, the FALSE answer is:
-
A.
Suprasellar arachnoid cysts arise from an imperforate membrane of Liliequist.
-
B.
The wall of an arachnoid cyst is typically pale, translucent, and avascular.
-
C.
Adult ventricular arachnoid cysts are very rare.
-
D.
Endoscopic cyst fenestration or excision are not treatment options.
-
E.
Third ventricular arachnoid cysts cause hydrocephalus.
Third ventricle arachnoid cyst, the FALSE answer is:
-
A.
Suprasellar arachnoid cysts arise from an imperforate membrane of Liliequist.
-
B.
The wall of an arachnoid cyst is typically pale, translucent, and avascular.
-
C.
Adult ventricular arachnoid cysts are very rare.
-
D.
Endoscopic cyst fenestration or excision are not treatment options.
-
E.
Third ventricular arachnoid cysts cause hydrocephalus.
Answer D
-
Endoscopic approaches might be considered owing to their being less invasive and giving a further chance of ETV.
-
8.
Third ventricle chordoid glioma, the FALSE answer is:
-
A.
WHO grade II.
-
B.
Typical location is in the suprasellar region and the anterior part of the third ventricle.
-
C.
Homogenously enhancing on MRI.
-
D.
Vimentin is negative in chordoid glioma.
-
E.
GFAP is positive marker of chordoid glioma.
Third ventricle chordoid glioma, the FALSE answer is:
-
A.
WHO grade II.
-
B.
Typical location is in the suprasellar region and the anterior part of the third ventricle.
-
C.
Homogenously enhancing on MRI.
-
D.
Vimentin is negative in chordoid glioma.
-
E.
GFAP is positive marker of chordoid glioma.
Answer D
-
GFAP and Vimentin are strongly positive immunohistochemical markers of Chordoid glioma in all reported cases.
-
9.
Third ventricle choroid plexus papilloma, the FALSE answer is:
-
A.
Most commonly affect young children under the age of five.
-
B.
Tumor is neuroectodermal in origin.
-
C.
CPP commonly progresses to become malignant.
-
D.
High vascularity of the tumor makes GTR challenging.
-
E.
MRI appears as homogeneous or heterogeneous tumors with a cauliflower appearance.
Third ventricle choroid plexus papilloma, the FALSE answer is:
-
A.
Most commonly affect young children under the age of five.
-
B.
Tumor is neuroectodermal in origin.
-
C.
CPP commonly progresses to become malignant.
-
D.
High vascularity of the tumor makes GTR challenging.
-
E.
MRI appears as homogeneous or heterogeneous tumors with a cauliflower appearance.
Answer C
-
Choroid plexus papilloma is treated with surgery and rarely progresses to become malignant.
-
10.
Hamartomas of the tuber cinereum, the FALSE answer is:
-
A.
Congenital, nonneoplastic heterotopias.
-
B.
Grossly may be pedunculated or sessile.
-
C.
Hypointense relative to gray matter on T1- and T2-weighted images.
-
D.
Associated with precocious puberty.
-
E.
Associated with gelastic epilepsy, resulting in spasmodic laughter.
Hamartomas of the tuber cinereum, the FALSE answer is:
-
A.
Congenital, nonneoplastic heterotopias.
-
B.
Grossly may be pedunculated or sessile.
-
C.
Hypointense relative to gray matter on T1- and T2-weighted images.
-
D.
Associated with precocious puberty.
-
E.
Associated with gelastic epilepsy, resulting in spasmodic laughter.
Answer C
-
Hamartoma is isointense with gray matter on T1-weighted images (T1WI) and hyperintense relative to gray matter on the second echo of the T2-weighted images (T2WI) with no enhancing on MRI.
-
11.
Pediatric third ventricle tumor, the FALSE answer is:
-
A.
Langerhans cell histiocytosis most commonly occurs in patients under the age of 2 years.
-
B.
Germinoma peaks at around 10–12 years.
-
C.
Germinoma arises at the anterior third ventricle more commonly than posterior aspect.
-
D.
Hypothalamic-chiasmatic pilocytic astrocytoma has mild enhancement.
-
E.
Craniopharyngioma peaks between the ages of 5 and 15 years.
Pediatric third ventricle tumor, the FALSE answer is:
-
A.
Langerhans cell histiocytosis most commonly occurs in patients under the age of 2 years.
-
B.
Germinoma peaks at around 10–12 years.
-
C.
Germinoma arises at the anterior third ventricle more commonly than posterior aspect.
-
D.
Hypothalamic-chiasmatic pilocytic astrocytoma has mild enhancement.
-
E.
Craniopharyngioma peaks between the ages of 5 and 15 years.
Answer C
-
Germinoma arises at the anterior third ventricle less commonly than at the posterior aspect of the ventricle.
-
12.
Adult third ventricle tumor, the FALSE answer is:
-
A.
Pituitary macroadenoma is the most common tumor affecting the anterior third ventricle.
-
B.
Papillary craniopharyngioma rarely has calcifications.
-
C.
Craniopharyngioma rarely manifests with hypopituitarism or diabetes insipidus.
-
D.
Craniopharyngioma is more often a homogeneous solid mass.
-
E.
Sellar meningiomas extending superiorly are distinguished by a dural base and sclerosis of skull base.
Adult third ventricle tumor, the FALSE answer is:
-
A.
Pituitary macroadenoma is the most common tumor affecting the anterior third ventricle.
-
B.
Papillary craniopharyngioma rarely has calcifications.
-
C.
Craniopharyngioma rarely manifests with hypopituitarism or diabetes insipidus.
-
D.
Craniopharyngioma is more often a homogeneous solid mass.
-
E.
Sellar meningiomas extending superiorly are distinguished by a dural base and sclerosis of skull base.
Answer C
-
Craniopharyngioma commonly manifests with hypopituitarism.
Craniopharyngioma commonly manifests with hypopituitarism.
-
13.
The posterior wall of the third ventricle tumors, the FALSE answer:
-
A.
Germinoma is the most common neoplasm.
-
B.
Pediatric pineal tumors rarely cause hydrocephalus when the tumor is still small.
-
C.
In children or adults, it can manifest as Parinaud syndrome.
-
D.
Pineocytoma (WHO grade I) comprises mature cells mostly in teens and young adults.
-
E.
Pineoblastoma (WHO grade IV) are highly malignant primitive tumors.
The posterior wall of the third ventricle tumors, the FALSE answer:
-
A.
Germinoma is the most common neoplasm.
-
B.
Pediatric pineal tumors rarely cause hydrocephalus when the tumor is still small.
-
C.
In children or adults, it can manifest as Parinaud syndrome.
-
D.
Pineocytoma (WHO grade I) comprises mature cells mostly in teens and young adults.
-
E.
Pineoblastoma (WHO grade IV) are highly malignant primitive tumors.
Answer B
-
Most pediatric pineal tumors manifest as third ventricle obstruction and hydrocephalus when the tumor is still small.
-
14.
Masses of the third ventricular floor, the FALSE answer is:
-
A.
Hamartoma of the tuber cinereum.
-
B.
The most frequently seen lesion is lipoma of the third ventricle.
-
C.
Basilar artery aneurysm.
-
D.
Dermoid cyst.
-
E.
Epidermoid.
Masses of the third ventricular floor, the FALSE answer is:
-
A.
Hamartoma of the tuber cinereum.
-
B.
The most frequently seen lesion is lipoma of the third ventricle.
-
C.
Basilar artery aneurysm.
-
D.
Dermoid cyst.
-
E.
Epidermoid.
Answer B
-
The most frequently seen lesion is a hamartoma of the tuber cinereum.
-
15.
The radiological appearance of third ventricle cyst, the FALSE answer is:
-
A.
Epidermoid cyst hypointense on T1WI, hyperintense T2WI with diffusion restriction.
-
B.
Dermoid cyst hypointense on T1WI, hyperintense T2WI with diffusion restriction.
-
C.
Colloid cyst hypointense on T1WI, hyperintense T2WI with homogenous enhancing.
-
D.
Arachnoid cyst hypointense on T1WI, hyperintense T2WI without diffusion restriction.
-
E.
Ependymoma hypointense (Solid part) on T1WI with restricted diffusion.
The radiological appearance of third ventricle cyst, the FALSE answer is:
-
A.
Epidermoid cyst hypointense on T1WI, hyperintense T2WI with diffusion restriction.
-
B.
Dermoid cyst hypointense on T1WI, hyperintense T2WI with diffusion restriction.
-
C.
Colloid cyst hypointense on T1WI, hyperintense T2WI with homogenous enhancing.
-
D.
Arachnoid cyst hypointense on T1WI, hyperintense T2WI without diffusion restriction.
-
E.
Ependymoma hypointense (Solid part) on T1WI with restricted diffusion.
Answer C
-
Colloid cyst hyperintense on T1WI, hypointense T2WI with rim enhancing.
-
16.
Third ventricle ependymomas, the FALSE answer is:
-
A.
The majority has slow growth and remain asymptomatic till it is large enough at diagnosis.
-
B.
Postoperative radiotherapy is the standard of care regardless of the extent of resection.
-
C.
Anaplastic ependymoma has a high recurrence rate.
-
D.
Ependymomas in the pediatric population are mostly supratentorial.
-
E.
Ependymomas in the adult population are mostly supratentorial.
Third ventricle ependymomas, the FALSE answer is:
-
A.
The majority has slow growth and remain asymptomatic till it is large enough at diagnosis.
-
B.
Postoperative radiotherapy is the standard of care regardless of the extent of resection.
-
C.
Anaplastic ependymoma has a high recurrence rate.
-
D.
Ependymomas in the pediatric population are mostly supratentorial.
-
E.
Ependymomas in the adult population are mostly supratentorial.
Answer D
-
At least half of ependymomas occur in the first two decades of life; they localize in the posterior fossa, particularly in small children. Ependymomas in the adult population are mostly supratentorial.
-
17.
Third ventricle ependymomas, the FALSE answer is:
-
A.
Common in neurofibromatosis type II.
-
B.
Ependymomas account for 2% of intracranial tumors in adults.
-
C.
Ependymomas account for 12% of intracranial tumors in children.
-
D.
Myxopapillary ependymoma is the most common histology.
-
E.
Subependymoma are extremely rare outside the ventricular system.
Third ventricle ependymomas, the FALSE answer is:
-
A.
Common in neurofibromatosis type II.
-
B.
Ependymomas account for 2% of intracranial tumors in adults.
-
C.
Ependymomas account for 12% of intracranial tumors in children.
-
D.
Myxopapillary ependymoma is the most common histology.
-
E.
Subependymoma are extremely rare outside the ventricular system.
Answer D
-
Myxopapillary ependymoma is the most common histology in filum terminale.
-
18.
Third ventricle central neurocytoma, the FALSE answer is:
-
A.
Can be extra ventricular neurocytoma.
-
B.
WHO grade III.
-
C.
Synaptophysin is positive.
-
D.
Neuron-specific enolase is negative.
-
E.
MIB-1 LI is the most accurate to determine prognosis and tumor grade.
Third ventricle central neurocytoma, the FALSE answer is:
-
A.
Can be extra ventricular neurocytoma.
-
B.
WHO grade III.
-
C.
Synaptophysin is positive.
-
D.
Neuron-specific enolase is negative.
-
E.
MIB-1 LI is the most accurate to determine prognosis and tumor grade.
Answer B
-
Central neurocytoma is WHO II.
-
19.
Third ventricle central neurocytoma, the FALSE answer is:
-
A.
Attached to the septum pellucidum near the foramen of Monro.
-
B.
CT scans calcifications up to 50% of all cases.
-
C.
Neuronal nuclei are positive.
-
D.
Neurocytoma can occur extraventricularly.
-
E.
More common in females than males.
Third ventricle central neurocytoma, the FALSE answer is:
-
A.
Attached to the septum pellucidum near the foramen of Monro.
-
B.
CT scans calcifications up to 50% of all cases.
-
C.
Neuronal nuclei are positive.
-
D.
Neurocytoma can occur extraventricularly.
-
E.
More common in females than males.
Answer E
-
Central neurocytomas are most prevalent among young adults. There is no specific correlation with genders.
-
20.
Third ventricle SEGA, the FALSE answer is:
-
A.
Most commonly in the region of the foramen of Monro.
-
B.
The most common symptom is new onset or worsened seizures.
-
C.
SEGAs occur in 50% of tuberous sclerosis patients.
-
D.
The mean age of presentation is 13 years.
-
E.
Everolimus is used in the treatment of SEGA.
Third ventricle SEGA, the FALSE answer is:
-
A.
Most commonly in the region of the foramen of Monro.
-
B.
The most common symptom is new onset or worsened seizures.
-
C.
SEGAs occur in 50% of tuberous sclerosis patients.
-
D.
The mean age of presentation is 13 years.
-
E.
Everolimus is used in the treatment of SEGA.
Answer C
-
SEGAs occur in 5–15% of TSC patients. These tumors are important to recognize because of their strong association with TSC.
-
21.
Third ventricle subependymoma, the FALSE answer is:
-
A.
WHO I.
-
B.
Its incidence in the third ventricle is higher than in the fourth ventricle.
-
C.
Most commonly occur in the fourth and fifth decades of life.
-
D.
Circumscribed non-enhancing mass lesions attached to the ventricular wall.
-
E.
Typically, patients are asymptomatic.
Third ventricle subependymoma, the FALSE answer is:
-
A.
WHO I.
-
B.
Its incidence in the third ventricle is higher than in the fourth ventricle.
-
C.
Most commonly occur in the fourth and fifth decades of life.
-
D.
Circumscribed non-enhancing mass lesions attached to the ventricular wall.
-
E.
Typically, patients are asymptomatic.
Answer B
-
Subependymoma is most commonly seen in the fourth ventricle as follows: fourth ventricle: 50–60%, lateral ventricles (usually frontal horns): 30–40%, and third ventricle: rare.
-
22.
Third ventricle surgical approaches, the FALSE answer is:
-
A.
Transcallosal is preferable in the absence of hydrocephalus.
-
B.
Transcortical approach has a risk of seizure of 5%.
-
C.
The supracerebellar infratentorial approach is best for colloid cysts.
-
D.
Occipital transtentorial approach used for posterior third ventricle tumors.
-
E.
The transcortical approach is favorable when hydrocephalus is present.
Third ventricle surgical approaches, the FALSE answer is:
-
A.
Transcallosal is preferable in the absence of hydrocephalus.
-
B.
Transcortical approach has a risk of seizure of 5%.
-
C.
The supracerebellar infratentorial approach is best for colloid cysts.
-
D.
Occipital transtentorial approach used for posterior third ventricle tumors.
-
E.
The transcortical approach is favorable when hydrocephalus is present.
Answer C
-
Parapineal lesions can be approached via a supracerebellar infratentorial approach or an occipital transtentorial approach.
-
23.
Approaches to the third ventricle, the FALSE answer is:
-
A.
Transient mutism occurs as a result of bilateral cingulate gyrus retraction.
-
B.
Interforniceal approach can result in memory loss.
-
C.
In transcallosal approach, the opening is 2/3 anterior and 1/3 posterior to the coronal suture to avoid motor strip.
-
D.
Disconnection syndrome is more common with anterior callosotomy.
-
E.
Possible pitfall entering a cavum septum pellucidum in transcallosal approach.
Approaches to the third ventricle, the FALSE answer is:
-
A.
Transient mutism occurs as a result of bilateral cingulate gyrus retraction.
-
B.
Interforniceal approach can result in memory loss.
-
C.
In transcallosal approach, the opening is 2/3 anterior and 1/3 posterior to the coronal suture to avoid motor strip.
-
D.
Disconnection syndrome is more common with anterior callosotomy.
-
E.
Possible pitfall entering a cavum septum pellucidum in transcallosal approach.
Answer D
-
Disconnection syndrome is more common with posterior callosotomy (near the splenium) where more visual information crosses. The risk is reduced by creating a callosotomy <2.5 cm in length.
-
24.
Colloid cyst management, the FALSE answer is:
-
A.
Bilateral VP shunt.
-
B.
Unilateral shunt with fenestration of the septum pellucidum.
-
C.
Surgical removal is recommended in patients <50 years at any cyst size with ventriculomegaly.
-
D.
A good result from stereotactic drainage is demonstrated by a hyperdense appearance on CT.
-
E.
Surgical removal is recommended when the cyst is >10 mm of size at any age.
Colloid cyst management, the FALSE answer is:
-
A.
Bilateral VP shunt.
-
B.
Unilateral shunt with fenestration of the septum pellucidum.
-
C.
Surgical removal is recommended in patients <50 years at any cyst size with ventriculomegaly.
-
D.
A good result from stereotactic drainage is demonstrated by a hyperdense appearance on CT.
-
E.
Surgical removal is recommended when the cyst is >10 mm of size at any age.
Answer D
-
Unsuccessful stereotactic aspiration is demonstrated by hyperdensity on CT due to high viscosity. Low viscosity demonstrates a hypo- or isodense CT appearance.
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Muhsen, B.A., Madi, H., Ismail, M., Esene, I.N., Andaluz, N. (2023). Third Ventricle: Pathology—Tumors. In: Salih, H.R., et al. Cerebral Ventricles . Springer, Cham. https://doi.org/10.1007/978-3-031-42342-0_6
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