Epilepsy and psychiatric problems in a patient with a large intracranial mass

Intracranial chondromas/osteochondromas are rare benign lesions usually attached to dura, located over the convexity of the skull containing benign cartilaginous/bony components; however, other locations are probable [1]. Intracranial osteochondromas usually originate more commonly extradurally from cartilaginous remnants at the base of the skull and less frequently intradurally from the dura mater of the convexity or falx cerebri [1, 2]. When developing supratentorially, the parafalcine frontoparietal location is the most common site [1, 2]. A 60-year-old female was presented to our clinic with 10-year history of generalized tonic–clonic seizures controlled medically; also, the patient suffered from frequent abrupt episodes of restlessness and anxiety with the duration of 5 min. The neurological exam was normal. Previous imaging studies had revealed a large calcified lesion in the left middle cranial fossa originating from skull base (Fig. 1). The imaging characteristics of the tumor as well as its indolent course prompted us to the probable diagnosis of intracranial osteochondroma. Surgery was not recommended because of the eloquent location of the lesion and the possible occurrence of major deficits following the surgery; in addition, the seizure attacks were medically controllable. Typically, the histomorphology of chondromas/osteochondromas looks like mature hyaline cartilage devoid of anaplastic proliferation of chondrocytes or nuclear atypia, in conjunction with bony components and a lobular arrangement of clusters of lacunae containing single chondrocytes [3].