Abstract
Background Intracranial chondromas are extremely rare and represent only 0.2% of all intracranial
primary neoplasms. The histologic appearance lacks nuclear atypism and mitoses, and
it usually shows low growth potential, although these benign features do not necessarily
imply a good prognosis.
Case Description A 44-year-old man was referred to our institution with a subarachnoid hemorrhage
(SAH). He had a history of SAH 5 years previously that was diagnosed as unknown etiology
at another hospital. Head magnetic resonance imaging showed a large tumor located
in the prepontine cistern and extending up to the interpeduncular cistern, and the
tumor was irregularly enhanced with contrast medium. Retrospective analysis of the
original computed tomography of 5 years earlier identified a small contrast enhancing
defect behind the dorsum sellae. Tumor removal was planned to prevent repeated SAH
and control the apparently growing tumor. An extended transsphenoidal approach was
performed. The pituitary gland was dissected from the bottom of the sellar floor and
transposed forward to the prechiasmatic cistern with preservation of the pituitary
stalk and its blood supply, and subtotal removal of the tumor was achieved. Postoperative
diabetes insipidus disappeared within a few days, and the patient was discharged without
neurologic or endocrinologic deficits. Histologic examination established the diagnosis
as chondroma without a sarcomatous component. Follow-up examination 3 months after
surgery showed a re-enlargement of the residual tumor, and gamma knife surgery was
performed.
Conclusions Intracranial chondroma sometimes manifests as intracranial hemorrhage and grows comparatively
rapidly in a short period despite the benign histologic features. A long and careful
follow-up period is essential.
Keywords
chondroma - extended transsphenoidal approach - pituitary transposition - subarachnoid
hemorrhage
