Chronic headache and obstructive hydrocephalus: A case of pilocytic astrocytoma in the third ventricle with detailed radiological and histopathological findings

Abstract

Pilocytic astrocytoma is a benign, slow-growing tumor classified as a WHO Grade I glioma, commonly affecting children and young adults. This case highlights the clinical, radiological, and histopathological features of a third-ventricle pilocytic astrocytoma and its management through endoscopic resection. An 18-year-old female presented with a one-year history of generalized headache, aggravated over the past month. Magnetic resonance imaging (MRI) revealed a mass lesion in the third ventricle, characterized by hypointensity on T1, hyperintensity on T2/FLAIR, no restriction on DWI, high signal intensity on ADC, and intense postcontrast enhancement. The lesion caused obstructive hydrocephalus in the bilateral lateral ventricles. The patient underwent successful endoscopic resection of the tumor. Histopathological examination confirmed pilocytic astrocytoma, showing biphasic patterns, Rosenthal fibers, and eosinophilic granular bodies. This case underscores the importance of multimodal diagnostic approaches and timely surgical intervention in managing pilocytic astrocytoma. Radiological imaging plays a pivotal role in preoperative planning, while histopathology confirms the diagnosis and guides further treatment.