Massive intratumoral hemorrhage following ventriculoperitoneal shunting procedure in an 8-year-old boy: A case report

Abstract

Background: Pineal region tumors comprise 0.4% of all central nervous system tumors in adults and 2.8% in children aged up to 19 years. Pineal gland tumors exhibit histological variability and necessitate a multidisciplinary approach. The first step in managing hydrocephalus is to treat it with either endoscopic third ventriculostomy (ETV) or a shunt surgery. Case Description: We present a case of a child with a massive intratumoral hemorrhage located in the pineal region. An 8-year-old boy with a suspected germinoma in the pineal area accompanying noncommunicating hydrocephalus underwent a right ventriculoperitoneal shunt procedure. He experienced a sudden decline of consciousness following the procedure. The subsequent imaging showed an extensive hyperdense lesion within the brain ventricles, indicating intratumoral hemorrhage. Given that intratumoral hemorrhage in pineocytoma following the placement of ventriculoperitoneal shunt surgery is uncommon, it is a significant factor contributing to morbidity and mortality. It should be considered when cerebrospinal fluid (CSF) diversion is performed before a craniotomy. Conclusion: A hypothesis suggests that changes in CSF flow after diverting CSF can be the main trigger for intratumoral hemorrhage although uncommon. In this study, we present our experience with our patients and provide a comprehensive evaluation of the existing literature.