Skull base chondrosarcoma presenting with hemorrhage.

A 34-year-old white man with a six month history of a feeling of déjà vu presented with an acute onset of headache and blurred vision associated with nausea and vomiting. Neurological examination was significant for a right third cranial nerve palsy. Computerized tomography (CT) demonstrated a 2.0 cm rim calcified right paracavernous mass with intratumoral hemorrhage and an adjacent 2.6 cm by 2.0 cm right temporal lobe hematoma. Intraventricular hemorrhage (IVH) was present in both lateral ventricles, right more than left (Figure 1). Diagnostic cerebral angiography demonstrated no evidence of aneurysm. Brain magnetic resonance (MR) imaging revealed a 2 cm mass in the right paracavernous region extending into the suprasellar region with heterogeneous signal intensity on T1and T2-weighted images and heterogeneous enhancement after gadolinium administration. Adjacent to the lesion was a right temporal lobe hematoma; intraventricular hemorrhage was also observed in the right lateral ventricle (Figure 2). The patient underwent a right pterional craniotomy for gross total resection of the tumour. Histopathological examination of the tumour demonstrated a low grade hyaline chondrosarcoma. The patient subsequently underwent proton beam radiotherapy and is currently 82 months out from surgery with no evidence of recurrence. Cranial chondrosarcomas are uncommon tumours which typically present with headache and visual disturbances1. The mean duration of symptoms at presentation ranges from 23 to 26 months1. These slow growing cartilaginous neoplasms generally become symptomatic secondary to local invasion and are only rarely associated with intratumoral or peritumoral hemorrhage2-9. The present case highlights a patient with a skull base chondrosarcoma who presented acutely secondary to intratumoral, intraparenchymal and intraventricular hemorrhage.