Cavernoma of the Third Ventricle: Study of a Pediatric Case and Literature Review

Introduction: Cavernomas are vascular lesions which occur very rarely in the ventricular system and especially in the pediatric population. We present the pediatric case of a cavernous malformation of the left lateral wall of the third ventricle and review the literature for pediatric population. Methods: A 17-month-old child presented with symptoms of raised intracranial hypertension, Magnetic resonance imaging disclosed characteristic images of a cavernoma in the third ventricle associated with hydrocephalus. The patient underwent an uneventful surgical excision by a transcallosal and transventricular approach. Because of a relapse of the cavernoma from a little remnant after one year a second surgery was needed with an excellent final radiological and clinical outcome after. Results: A literature review of 128 children with intracerebral cavernomas, 22 were intraventricular with only 7 in the third ventricle. The mean age was 8 years with two peaks at 0 to 2 years (26.8%) and 13 to 16 years (35.7%). There were no preponderance of gender with only 4.8% of cases with multiple lesions and three cases of familial form. The most prominent presenting symptom was intracranial hypertension (57%), followed by seizures (14.3%), visual disturbance (14.3%), and endocrine disturbances (14.3%). Intraventricular cavernomas tend to growth with frequent hemorrhage presumably because of the absence of anatomical barrier at the ventricular side. Conclusions: The diagnosis of cavernoma in pediatric population should be considered with lesions of third ventricle. These lesions of benign nature have a high tendency for regrow, because of recurrent hemorrhages, if incompletely removed. A total excision is mandatory, despite the difficult location.