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[A Case of Mature Teratoma in the Third Ventricle with Holmes Tremor]
Masataka Mikai1, Ryo Matsuzaki, Chie Nakada
1Department of Neurosurgery(Omori), School of Medicine, Faculty of Medicine, Toho University.
Abstract:
Intracranial teratoma is a rare disease that frequently occurs in children and young adults. It comprises of approximately 0.1% of the brain tumors. We report a case of a large mature teratoma in the third ventricle with Holmes tremor. A 5-year-old boy presented with tremors 2 years ago. CT showed a 56×48 mm tumor in the third ventricle and hydrocephalus. The tumor was well demarcated from the surrounding brain tissue and contained calcification. MRI indicated a partially high-intensity signal on T1-weighted and T2-weighted images. The preoperative diagnosis was teratoma. Initially, the tumor was biopsied using neuroendoscopy and the Ommaya reservoir was set. The pathological results showed fat-like tissues and fibroblasts. Subsequently, the tumor was completely removed using the interhemispheric transcallosal transchoroidal approach. The tumor included fat and hair tissues. It also included calcification similar to that observed in a tooth. It was strongly adhered near the pineal gland. Pathologically, the diagnosis was a mature teratoma. Postoperatively, the tremor disappeared and the patient was discharged from the hospital without neurological deficits. We believe that compression of the Guillain-Mollaret triangle was relieved by removal of the tumor. Hence, the tremor disappeared after the operation.
Insights
A rare intracranial teratoma in a child caused tremors by compressing brain structures. Surgical removal of this mature teratoma resolved the tremors and neurological deficits.
Area of Science:
- Neuro-oncology
- Pediatric Neurosurgery
Background:
- Intracranial teratomas are rare brain tumors, primarily affecting children and young adults, accounting for about 0.1% of all brain tumors.
- Holmes tremor is a specific type of tremor often associated with lesions affecting the brainstem or cerebellum.
Observation:
- A 5-year-old boy presented with a 2-year history of tremors, diagnosed as Holmes tremor.
- Imaging revealed a large (56x48 mm) mature teratoma in the third ventricle causing hydrocephalus, with calcifications and mixed T1/T2 signal intensities.
- The teratoma contained fat and hair-like tissues, adhered near the pineal gland.
Findings:
- Surgical debulking via neuroendoscopy followed by complete resection via an interhemispheric transcallosal transchoroidal approach successfully removed the mature teratoma.
- Post-operative pathology confirmed a mature teratoma with characteristic tissue components.
- The patient experienced complete resolution of tremors and was discharged without neurological deficits.
Implications:
- Complete surgical resection of intracranial teratomas can lead to excellent outcomes, including the resolution of associated neurological symptoms.
- Relief of compression on the Guillain-Mollaret triangle is hypothesized to be the mechanism for tremor resolution in this case.
- This case highlights the importance of considering teratomas in the differential diagnosis of pediatric brain tumors presenting with movement disorders.
