Chordoid glioma in the thalamus of a child: Rare location an
Chordoid glioma is a rare intracranial tumor, which usually occurs in middle-aged female patients, mainly in the third ventricle, hypothalamus, and suprasellar region. It can reportedly occur in the temporal-parietal lobe, the occipital horn of the lateral ventricle, and the left thalamus. A 10-year-old female child was hospitalized with a paroxysmal headache that had persisted for 2 weeks. The physical examination on admission showed that the patient was lucid and demonstrated language fluency, but was otherwise uncooperative during the physical examination. There was no hoarseness, choking when drinking water, or difficulty swallowing. There was no atrophy or hypertrophy of the overall body muscle, the muscle tension of the extremities was normal, and the muscle strength of the extremities was Grade 5. The bilateral finger nose and calcaneal knee tibia tests were stable and accurate. The bilateral Babinski sign was negative, the neck was soft and the Kirschner sign was negative.

CT revealed a low-density oval mass in the right thalamus. MRI examination showed an oval, solid cystic mass in the right thalamic region with clear boundaries; the cystic area (pentagram) was mostly in the center of the lesion. T1W images showed hypointensity, and T2W images showed hyperintensity. Fluid-attenuated inversion recovery (FLAIR) showed slight hyperintensity, and diffusion-weighted imaging (DWI) showed hypointensity; the solid part (short white arrow) was mostly located at the periphery of the lesion. T1W images showed slight hypointensity, T2W images and FLAIR showed slight hyperintensity, and DWI showed isointensity. There was a slightly hyperintense nodular signal visible on T2W images and on FLAIR in the central part of the cystic region, and DWI showed slight hyperintensity. The central nodule was enhanced with annular enhancement, but there was no readily visible enhancement in the cystic part and the surrounding solid part. There was no readily visible edema zone around the tumor, and the tumor compressed the third ventricle to cause obstructive hydrocephalus. Low-grade glioma was diagnosed before surgery.

The patient underwent resection of the right thalamic space-occupying lesions via a transcortical, right lateral ventricle approach under general anesthesia in the morning. On the second day after surgery, CT showed that most of the tumor had been resected, and there was some bleeding in the surgical area. Postoperative pathology showed that the tumor cells were sparse, the arrangement was dense, the heterotype was not obvious, the blood vessels did not proliferate obviously, some of the tumor cells degenerated, and the interstitial myxoid degenerated. The patient had recovered well by the 23rd day after the operation and mentioned no particular discomfort. Physical examination showed that the patient could speak clearly and cooperated with the physical examination. The head incision healed well. Pupil dilation occurred evenly across both eyes; the patient showed direct and indirect light reflex, and eye movement was normal. Muscle tension was normal, muscle strength in both limbs was Grade 5, and the bilateral pathological reflex was negative. The patient was discharged in a stable condition.