Primary Intracranial Sarcoma Presenting as Chronic Subdural Fluid Collections in a Child
Related Experiment Video
Updated: Apr 4, 2026
Author Spotlight: A Single-Entry Point Endoscopic Intraventricular Approach for Third Ventriculostomy and Pineal Biopsy
Published on: June 28, 2024
Chad A Glenn1, Kar-Ming Fung2, Hurtis J Tullos1
1Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
Insights
Pediatric subdural fluid collections mimicking hematoma may mask rare primary intracranial sarcomas. Early contrasted MRI is crucial for diagnosis, as cytology can be misleading.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Neuroradiology
Background:
- Chronic subdural hematoma in children often stems from trauma and is typically managed conservatively if asymptomatic.
- Primary intracranial sarcomas are rare and can be misdiagnosed as subdural hematomas.
- Subdural fluid collections in children can present diagnostic challenges, especially when they do not resolve as expected.
Observation:
- A case is presented of a child with a history of subdural fluid collections initially managed conservatively.
- The patient later developed neurological deficits, including weakness and seizures, with an increase in subdural fluid.
- Despite normal initial neurological exams and negative cytology, imaging revealed enhancing masses.
Findings:
- A primary intracranial mucoid spindle cell sarcoma was diagnosed after conservative management failed.
- Magnetic resonance imaging (MRI) was key in identifying enhancing masses within the subdural collection.
- Surgical intervention was required for diagnosis and treatment of the sarcoma.
Implications:
- Early contrasted MRI is recommended for pediatric subdural fluid collections that are asymmetric or persistent.
- A normal neurological exam and negative cytology do not rule out the possibility of sarcoma.
- Prompt and accurate diagnosis is vital for effective oncological management in pediatric intracranial tumors.
Background:
Chronic subdural hematoma in the pediatric population often results from trauma. Asymptomatic and benign-appearing subdural collections are generally managed conservatively without operative intervention. Primary intracranial sarcomas are uncommon entities. Diagnosis of sarcoma can be difficult because these lesions often manifest as apparent hematoma.
Case Description:
Presented is the case of a primary intracranial mucoid spindle cell sarcoma that arose in a child with a history of benign-appearing bilateral subdural fluid collections in the setting of nonaccidental trauma. The patient was initially managed conservatively because her neurological examination result was normal and her subdural collections decreased in size on repeated imaging. The collections did not resolve completely. Years later, she exhibited weakness, seizure, and an increase in the size of her subdural fluid collection. Subdural drainage was attempted without significant effect. Cytologic assessment of fluid was negative for malignant cells. Magnetic resonance imaging revealed multiple enhancing masses along the subdural collection. The patient eventually underwent craniotomy in which a diagnosis of sarcoma was obtained. Pathological and radiographic findings as well as oncological management are reviewed. The authors also review the natural history and treatment of primary intracranial sarcoma in the pediatric population.
Conclusions:
Early contrasted magnetic resonance imaging should be obtained in patients with subdural fluid collections that appear asymmetric or do not resolve in the expected time course, despite having a normal neurologic examination result. Negative cytologic assessment does not exclude sarcoma diagnosis.
