Journal of neurosurgery. Case lessons最新文献_第5页

Calcifying pseudoneoplasm of the neuraxis progressing to G5/PDGFRA subgroup glioblastoma in a United States Army veteran with a history of head trauma and germline POT1 and EPHB2 mutations: illustrative case. 美国陆军退伍军人头部外伤史和种系POT1和EPHB2突变，神经轴钙化假瘤进展为G5/PDGFRA亚群胶质母细胞瘤：说明性病例

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25152

Maria-Magdalena Georgescu, Adriana Olar, William Daniel Zollinger

{"title":"Calcifying pseudoneoplasm of the neuraxis progressing to G5/PDGFRA subgroup glioblastoma in a United States Army veteran with a history of head trauma and germline POT1 and EPHB2 mutations: illustrative case.","authors":"Maria-Magdalena Georgescu, Adriana Olar, William Daniel Zollinger","doi":"10.3171/CASE25152","DOIUrl":"10.3171/CASE25152","url":null,"abstract":"Background: Trauma-associated glioblastoma has been previously described, albeit without molecular characterization.Observations: The authors show the integrated clinical/pathologic/molecular analysis of a glioblastoma developing 43 years after head trauma sustained by a United States veteran. An epileptogenic benign lesion developed at the trauma site, followed 34 years later by a calcified lesion diagnosed as calcifying pseudoneoplasm of the neuraxis (CAPNON) that recurred 9 years later as glioblastoma with heterotopic/metaplastic ossification. Genomic analysis showed novel germline mutations in the telomere maintenance factor POT1 p.W184* and receptor tyrosine kinase (RTK) EPHB2 p.W792*. The somatic alterations included second-hit POT1 p.D163Y mutation, CDKN2A/2B homozygous loss, DNMT3A mutation and PDGFRA amplification, classifying this glioblastoma in the G5/PDGFRA molecular subgroup. Proliferation markers, PDGFRA, MAPK feedback inhibitors, and EPHB1 showed high expression, whereas EPHB3 and EPHA7 showed the highest expression of all glioblastomas. Following gross-total resection, the patient received adjuvant radiotherapy and temozolomide and died 16.3 months later.Lessons: This is the first report of CAPNON progression to glioblastoma and of molecularly characterized glioma occurring decades after head trauma. A multifactorial etiology including genetic predisposition and posttraumatic repair is hypothesized. The discussion presents possible roles of EPH RTKs in posttraumatic repair and CAPNON, and of POT1 and PDGFRα in subsequent progression to glioblastoma. https://thejns.org/doi/10.3171/CASE25152.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087366/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Staged approach to managing aggressive clival lesions extending into occipital condyles illustrated by a rare urothelial carcinoma metastasis: illustrative case. 分阶段的方法来处理侵袭性斜坡病变延伸到枕髁的罕见尿路上皮癌转移：说导性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25139

Kishore Balasubramanian, Jeffrey A Zuccato, Ian F Dunn

{"title":"Staged approach to managing aggressive clival lesions extending into occipital condyles illustrated by a rare urothelial carcinoma metastasis: illustrative case.","authors":"Kishore Balasubramanian, Jeffrey A Zuccato, Ian F Dunn","doi":"10.3171/CASE25139","DOIUrl":"10.3171/CASE25139","url":null,"abstract":"Background: Chordomas and chondrosarcomas are the most common malignant primary clival tumors. Clival metastases are infrequent, and urothelial carcinoma is a rare metastasis source. The case presented shows an isolated clival and bilateral occipital condyle metastasis from urothelial carcinoma without active cancer, initially suspected to be a chordoma.Observations: A 68-year-old male with urothelial carcinoma resected 2.3 years prior presented with neck pain and cranial nerve XII palsies. Imaging revealed a clival lesion extending into bilateral occipital condyles, thought to most likely be a chordoma as workup revealed no active systemic cancer. A staged surgical approach was planned beginning with a posterior resection for tissue diagnosis and craniocervical stabilization, to be followed with additional surgical approaches for the remainder of bulk disease. Final pathology revealed metastatic urothelial carcinoma. Accordingly, the patient was treated with radiotherapy and systemic therapy instead of the endonasal transclival and bilateral transcondylar additional staged resections that were planned if the tumor had been a chordoma.Lessons: This approach of upfront diagnosis and stabilization allowed identification of a rare and unexpected differential diagnosis prior to coordinating maximal resection across three additional staged surgeries in a patient thought to have a clival chordoma extending to the bilateral occipital condyles. https://thejns.org/doi/10.3171/CASE25139.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087367/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Atraumatic atlantoaxial subluxation in pediatric enthesitis-related juvenile idiopathic arthritis: illustrative case. 小儿麻炎相关青少年特发性关节炎的非外伤性寰枢半脱位：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE25121

Amasa Saketh, Sean O'Leary, Teerth Y Patel, Frances Morden, Christian Ogasawara, Brian Oliver, Nathan Pratt

{"title":"Atraumatic atlantoaxial subluxation in pediatric enthesitis-related juvenile idiopathic arthritis: illustrative case.","authors":"Amasa Saketh, Sean O'Leary, Teerth Y Patel, Frances Morden, Christian Ogasawara, Brian Oliver, Nathan Pratt","doi":"10.3171/CASE25121","DOIUrl":"10.3171/CASE25121","url":null,"abstract":"Background: Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatological disease, yet cervical spine involvement remains an underrecognized but potentially devastating manifestation. Atlantoaxial subluxation (AAS) arises from inflammatory changes causing ligamentous laxity and instability.Observations: A 13-year-old female presented with progressive neck pain. Imaging revealed a 10-mm atlantodental interval on CT, along with hyperintensity and stretching of the transverse atlantal ligament on MRI. She underwent a posterior C1-2 open reduction and fusion. Subsequent rheumatological workup confirmed enthesitis-related JIA, based on polyarticular arthritis, HLA-B27 positivity, and elevated inflammatory markers. To contextualize this case, the authors performed a systematic review and meta-analysis of JIA-related AAS across 21 studies. The pooled incidence of AAS was 14%, with a mean age at JIA onset of 8.47 years and a female predominance of 62%. Enthesitis-related arthritis emerged as the most frequently reported subtype, and 94.4% of patients with AAS improved posttreatment.Lessons: This case and supporting literature underscore the importance of early detection and multidisciplinary management of AAS in pediatric patients with JIA. Timely neurosurgical stabilization, combined with optimized immunosuppressive therapy, can prevent neurological compromise. Future research should focus on standardized diagnostic thresholds and outcome measures to guide best practices. https://thejns.org/doi/10.3171/CASE25121.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087365/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Incidental pediatric intraparenchymal meningioma: illustrative case. 小儿先天性脑实质内脑膜瘤：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE24611

Adriano M Lino-Filho, Bárbara A Morais, Mateus Neves Faria Fernandes, Jairo Porfirio Oliveira-Junior, Bruna Estrozi, Weder Silva Borges-Junior, Paulo Ronaldo J Ribeiro

{"title":"Incidental pediatric intraparenchymal meningioma: illustrative case.","authors":"Adriano M Lino-Filho, Bárbara A Morais, Mateus Neves Faria Fernandes, Jairo Porfirio Oliveira-Junior, Bruna Estrozi, Weder Silva Borges-Junior, Paulo Ronaldo J Ribeiro","doi":"10.3171/CASE24611","DOIUrl":"10.3171/CASE24611","url":null,"abstract":"Background: Meningiomas are the most common benign tumors among CNS neoplasms. In the pediatric population, however, they account for only 0.4%-4.6% of all intracranial neoplasms; they are rare inside the brain parenchyma and are frequently confused with other entities, such as glioneuronal tumors and cavernomas, among others.Observations: The authors describe the case of a 4-year-old male who presented to the emergency department for evaluation of periorbital cellulitis and was incidentally diagnosed with a brain tumor. MRI demonstrated an expansive heterogeneous lesion, 2.2 × 1.9 × 1.8 cm, in the left lingual gyrus. Spectroscopy and perfusion imaging suggested a low-grade glioneuronal tumor. After thorough discussion, the family and medical team elected to pursue surgical treatment. The patient had an uneventful postoperative recovery, and subsequent pathological and immunohistochemical analysis confirmed the diagnosis of a fibrous meningioma (WHO grade 1).Lessons: Intraparenchymal meningiomas are a rare and misdiagnosed tumor, especially in the pediatric age group, and therefore are not usually considered in the differential diagnosis of intra-axial neoplasms in children. When suspected, surgery may be encouraged due to the tendency of these tumors to exhibit more aggressive behavior compared with adult meningiomas. https://thejns.org/doi/10.3171/CASE24611.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103345","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ruptured distal middle cerebral artery aneurysm in a pediatric patient: illustrative case. 1例儿童患者大脑中远端动脉瘤破裂：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-19 DOI: 10.3171/CASE24373

Jonathan Espinosa, Gregory Murtha, Samon Tavakoli, Lee A Birnbaum, Justin Mascitelli, Fadi Al Saiegh

{"title":"Ruptured distal middle cerebral artery aneurysm in a pediatric patient: illustrative case.","authors":"Jonathan Espinosa, Gregory Murtha, Samon Tavakoli, Lee A Birnbaum, Justin Mascitelli, Fadi Al Saiegh","doi":"10.3171/CASE24373","DOIUrl":"10.3171/CASE24373","url":null,"abstract":"Background: Pediatric intracranial aneurysms (IAs) are rare, with an estimated occurrence of less than 5% of all IAs. The pathology of pediatric aneurysms may differ from adult IAs and require additional workup. Management options for pediatric aneurysms include both endovascular and open procedures. The authors report the case of a 7-year-old male with a large, partially thrombosed distal middle cerebral artery (MCA) aneurysm.Observations: The patient presented with left hemiparesis. The initial CT imaging showed an intraparenchymal hemorrhage (IPH) in the right frontal lobe. Digital subtraction angiography (DSA) showed a large, partially thrombosed distal MCA aneurysm. A right frontal craniotomy was performed for aneurysm clipping, excision, and hematoma evacuation. Intraoperative DSA was utilized to confirm the absence of residual aneurysm. At the 6-month follow-up appointment, the patient had returned to his neurological baseline. He continues annual cerebrovascular radiographic surveillance.Lessons: Pediatric aneurysms presenting with IPH are exceedingly rare. In this patient, an open surgical intervention was favored due to the presence of an IPH and the distal location of the aneurysm. Pediatric aneurysms may have a different etiology than that of adults. Because of this difference, these lesions require special considerations with regard to workup and treatment. https://thejns.org/doi/10.3171/CASE24373.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12087364/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144103371","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Adult H3 K27-altered, H3.3 K27-mutant diffuse midline glioma affecting the conus medullaris: illustrative case. 成人H3 k27改变，H3.3 k27突变的弥漫性中线胶质瘤影响髓圆锥：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-12 DOI: 10.3171/CASE24879

Andrei Sincari, Saif Yousif, Thomas Robertson, Yi-Tung Tom Huang, Hamish Alexander

{"title":"Adult H3 K27-altered, H3.3 K27-mutant diffuse midline glioma affecting the conus medullaris: illustrative case.","authors":"Andrei Sincari, Saif Yousif, Thomas Robertson, Yi-Tung Tom Huang, Hamish Alexander","doi":"10.3171/CASE24879","DOIUrl":"10.3171/CASE24879","url":null,"abstract":"Background: Diffuse midline glioma (DMG) H3 K27-altered is a rare CNS tumor that predominantly affects midline structures in children. A relatively new subtype of glioma, it was first classified in 2016 and was further expanded in 2021 to include 4 molecular subtypes. While reported on in children, this is the first reported case of an H3.3 K27-mutant subtype of DMG affecting the conus medullaris in adults.Observations: The authors report the case of a 62-year-old man with gradual onset of bladder and lower-limb dysfunction over a 6-month period. Because of the patient's synchronous diagnosis of lymphoma, CSF sampling and positron emission tomography (PET) were initially utilized. Ultimately, an open biopsy was required to yield a diagnosis of H3 K27-altered DMG. After multiple disciplinary team discussions and discussions with the patient, radiotherapy was commenced.Lessons: H3 K27-altered DMG affecting the conus medullaris is a very rare tumor that can present with gradual-onset lower-limb dysfunction and can be difficult to diagnose on traditional imaging alone. This case emphasized the continued importance of tissue sampling, with further research required on the utility of PET, CSF sampling, and the significance of molecular subtyping on treatment response and prognosis. https://thejns.org/doi/10.3171/CASE24879.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070302/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Middle meningeal artery embolization for treatment of bilateral mixed-attenuation subdural hematomas in an infant: illustrative case. 脑膜中动脉栓塞治疗婴儿双侧混合衰减硬膜下血肿：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-12 DOI: 10.3171/CASE2579

Jarius A Garner, Timi Akinwunmi-Williams, Dylan-Alexis Starks, Cylaina Bird, Frank R Hellinger, James E Baumgartner, Keyne K Johnson

{"title":"Middle meningeal artery embolization for treatment of bilateral mixed-attenuation subdural hematomas in an infant: illustrative case.","authors":"Jarius A Garner, Timi Akinwunmi-Williams, Dylan-Alexis Starks, Cylaina Bird, Frank R Hellinger, James E Baumgartner, Keyne K Johnson","doi":"10.3171/CASE2579","DOIUrl":"10.3171/CASE2579","url":null,"abstract":"Background: Chronic subdural hematoma (cSDH) is a collection of blood that accumulates between the dura and arachnoid meningeal layers, commonly associated with traumatic tearing of the cortical bridging veins and a chronic inflammatory response. Chronic SDH predominantly affects elderly populations, with rare occurrences in children. Middle meningeal artery (MMA) embolization is a minimally invasive procedure proven in adult neurological care of cSDH. However, the efficacy of this treatment in the management of cSDH in the pediatric population is yet to be proven.Observations: A 5-month-old female patient with a history of von Willebrand disease presented at the age of 2 months with irritability, seizures, and bilateral ecchymosis. Subsequent imaging revealed bilateral SDHs over the cerebral and cerebellar hemispheres. She underwent bilateral burr hole drainage and subdural to peritoneal shunts that ultimately required several revisions, including a valve replacement due to shunt malfunctions. Given conventional treatment failure, she was then treated with bilateral MMA embolization, resulting in resolution of her acute, subacute, and chronic SDH. At the 15-month follow-up, she met all developmental milestones, was neurologically intact, seizure free, and MRI did not reveal a cSDH.Lessons: MMA embolization is effective in the treatment of bilateral mixed-attenuation SDHs after failure of conventional treatments in pediatric populations. https://thejns.org/doi/10.3171/CASE2579.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144039796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Surgical management of craniocervical dissociation secondary to transclival fracture and bilateral occipital condyle disruption: illustrative case. 经骨骨折和双侧枕髁断裂继发的颅颈分离的手术治疗：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-12 DOI: 10.3171/CASE24847

Sarah C Larson, Katherine M Bunch, Daniel K Resnick

引用次数: 0

Innovative neurovascular decompression for chronic intractable hiccups secondary to vertebral artery dolichoectasia: a novel surgical technique. Illustrative case. 创新神经血管减压术治疗椎动脉延张性慢性顽固性呃逆：一种新的外科技术。说明情况。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-12 DOI: 10.3171/CASE2552

Ahmad Abdullah Altayyar, Benjamin Brokinkel, Uta Schick, Panagiotis Fistouris

{"title":"Innovative neurovascular decompression for chronic intractable hiccups secondary to vertebral artery dolichoectasia: a novel surgical technique. Illustrative case.","authors":"Ahmad Abdullah Altayyar, Benjamin Brokinkel, Uta Schick, Panagiotis Fistouris","doi":"10.3171/CASE2552","DOIUrl":"10.3171/CASE2552","url":null,"abstract":"Background: Chronic continuous hiccups can significantly impair quality of life and may lead to considerable psychological stress in affected patients. Although often idiopathic, hiccups can also be caused by local compression of the brainstem.Observations: The authors present the case of a female patient with refractory hiccups caused by brainstem compression by vertebral artery dolichoectasia. Complete recovery was achieved through an innovative surgical approach involving microsurgical decompression of the medulla oblongata, which enabled direct visualization of the vertebral artery at its transition from the extradural to intradural space.Lessons: This case highlights the potential anatomical and structural causes of intractable hiccups, underscores the importance of thorough neuroradiological evaluation, and ultimately advocates for an individualized surgical approach in such cases. https://thejns.org/doi/10.3171/CASE2552.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070301/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A rare presentation of pediatric germinoma mimicking optic pathway glioma: illustrative case. 小儿生殖细胞瘤模拟视神经胶质瘤的罕见表现：说明性病例。

Journal of neurosurgery. Case lessons Pub Date : 2025-05-12 DOI: 10.3171/CASE24804

Stenia Accilien, William S Coggins, Deanna Sasaki-Adams, Gregory W Albert, Kevin J Bielamowicz, David Wilson, Charles M Glasier, Murat Gokden, Tomoko Tanaka

{"title":"A rare presentation of pediatric germinoma mimicking optic pathway glioma: illustrative case.","authors":"Stenia Accilien, William S Coggins, Deanna Sasaki-Adams, Gregory W Albert, Kevin J Bielamowicz, David Wilson, Charles M Glasier, Murat Gokden, Tomoko Tanaka","doi":"10.3171/CASE24804","DOIUrl":"10.3171/CASE24804","url":null,"abstract":"Background: Intracranial germinomas are rare pediatric tumors classically occurring in the pineal region, the infundibular recess, and septal region. Hypothalamic-optic pathway gliomas are typically pilocytic astrocytomas that can occur at any point along the optic pathway or within the hypothalamus. Germinomas are highly radiosensitive and chemotherapy-sensitive with an overall good prognosis after treatment. In contrast, hypothalamic-optic pathway gliomas are typically managed with observation if asymptomatic and treated with chemotherapy or targeted therapies if they are symptomatic or progressive.Observations: Suprasellar germinomas are a known alternative location; however, suprasellar germinomas extending along the optic pathway are exceedingly rare. Neurosurgeons, neuroradiologists, and neuro-oncologists should consider germinomas when crafting a differential around a midline suprasellar lesion involving the optic pathway. Given the differences in treatment of a germinoma versus an optic pathway glioma, obtaining sufficient tissue for a diagnosis is paramount in these rare cases with radiographic equipoise.Lessons: The authors report a case of a suprasellar germinoma mimicking an optic pathway glioma in its radiographic appearance. The intraoperative appearance of the lesion during the attempted transsphenoidal biopsy appeared consistent with an optic pathway glioma. Subsequent biopsy via a pterional approach confirmed the diagnosis of germinoma. https://thejns.org/doi/10.3171/CASE24804.","PeriodicalId":94098,"journal":{"name":"Journal of neurosurgery. Case lessons","volume":"9 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144046604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0