Silent growth, striking impact: A rare case of intracranial chondroma and review of literature.

Background: Chondromas are benign tumors accounting for 0.2-0.3% of all intracranial tumors. They are composed of embryonic cartilaginous material and mostly occur in extradural locations or less frequently in paranasal sinuses, choroid plexus, and dura. In this report, we present a case where a young patient presented with bifrontal parafalcine chondroma.

Case description: A 32-year-old female presented with headache for the past 2 years along with blurry vision and forgetfulness for the past 2 months. Magnetic resonance imaging (MRI) brain showed a bifrontal mixed-intensity lesion located in the parasagittal region on T2-weighted sequence with areas of hypo and hyperintensities. The lesion showed areas of heterogeneous contrast enhancement. She underwent neuronavigation-guided bifrontal craniotomy and maximum safe resection of the lesion. Postoperative MRI showed near total resection of the lesion along with development of acute infarcts in bilateral frontotemporal lesion. Her postoperative course was complicated by anterior cerebral artery territory infarcts, contributing to low Glasgow Coma Scale and left-sided weakness. She experienced recurrent seizures and respiratory complications, necessitating elective tracheostomy. After a 25-day hospital stay, she was discharged. At 4-month follow-up, she showed significant neurological improvement, including resolution of lower-limb weakness and tracheostomy removal. However, MRI suggested tumor recurrence, which remained stable at 6- and 9-month follow-ups.

Conclusion: Intracranial chondromas are rare neoplasms of the skull mostly presenting in the third decade of life. They are slow growing and can gain enormous size leading to chronic symptoms, particularly long-standing headaches. There is high variability in the location of these tumors, and our analysis suggests that more than 30% of the tumors arise from convexity. Chondromas are a rare entity which makes it difficult to distinguish from craniopharyngioma, pituitary adenoma, and meningioma, so these should be considered as important differentials. Our literature review showed 73.3% of the chondromas appeared hypointense on T1 sequence and 46.7% were found to be heterogenous on T2 sequence which aligns with previous studies. Gross total resection is the gold standard treatment while the role of radio and chemotherapy remains controversial.