Pineocytoma With Massive Intratumoral Hemorrhage After Ventriculoperitoneal Shunt —Case Report—

Ventriculo-peritoneal (V-P) shunting is an accepted procedure before a direct approach to large tumors producing obstructive hydrocephalus. However, it has been associated with some complications. Intratumoral hemorrhage is an uncommon but fatal complication of V-P shunt insertion. The exact mechanism of this complication is unknown, but several mechanisms have been proposed including rapid lowering of intracranial pressure following V-P shunt placement or cerebrospinal fluid (CSF) drainage and sudden decrease in CSF volume and pressure after V-P shunting. We report an 8-year-old girl who presented with severe headache, double vision, and bilateral papilledema. Brain magnetic resonance imaging with and without gadolinium administration revealed a large tectal plate tumor compressing the aqueduct which caused hydrocephalus. Due to progressive decline in consciousness level, an emergency CSF diversion was planned and she underwent left side posterior parietal V-P shunt placement. Eight hours after V-P shunt insertion, she suddenly developed tonic-clonic seizures and collapsed into deep coma with dilated pupils and stopped breathing and died 1-day later. Histological examination of the autopsy specimen showed the tumor was a glioblastoma multiforme with massive intratumoral hemorrhage. The possible pathophysiological mechanisms of this fatal complication are discussed here and the pertinent literature is reviewed. It seems that endoscopic third ventriculostomy is the procedure of choice for CSF diversion in patients with tectal plate gliomas and decreases the occurrence of intratumoral hemorrhage.

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“…The exact mechanism of intratumoral hemorrhage after V-P shunt insertion is unknown, but several mechanisms have been proposed:[1234911121314]…”

Section: Discussionmentioning

confidence: 99%

“…[12] It most commonly occurs in glioblastoma multiforme (GBM), metastatic tumors, and pituitary adenomas. [1234]…”

Section: Introductionmentioning

confidence: 99%

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

Khalatbari¹,

Khalatbari

Moharamzad³

2014

J Pediatr Neurosci

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“…It has however been reported, only in the acute setting, in a small number of individual case reports following CSF diversion for pineal tumours without biopsy. The presentations varied from a small asymptomatic bleed [8], acute deterioration at two hours [9] and on day two [10], and a fatal bleed at 5 hours [11]. Clinically significant haemorrhage post-CSF diversion for obstructive hydrocephalus caused by other posterior fossa tumours, again without biopsy, has also been described [12][13][14][15][16][17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review

Colditz

Winter²

2013

WJNS

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Intraparenchymal haemorrhage in a pineal germinoma is a very rare, though clinically significant event. We report the first case of a significantly delayed intraparenchymal haemorrhage in a pineal germinoma, 14 days after endoscopic third ventriculostomy (ETV), causing precipitous patient deterioration. We discuss potential contributing pathophysiological factors, and seek to illustrate that knowledge of its occurrence, and associated morbidity, is clinically significant in managing pineal germinoma patients with acute deterioration post obstructive hydrocephalus CSF diversion.

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“…The possible causes of pineal hemorrhages are pineal region tumors,8-14 vascular malformations and pineal cysts,15-17 and tumors are the most common cause of pineal hemorrhage. Various pineal tumors have been reported to cause intra-tumoral hemorrhage including ganglioglioma,18 pineocytoma,19 choriocarcinoma,10,11 meningioma20 and hemangiopericytoma 21. Embryonal carcinoma and metastatic melanoma are also included in the differential diagnosis 9,22.…”

Section: Discussionmentioning

confidence: 99%

Pineal Cavernous Malformations: Report of Two Cases

et al. 2005

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Pineal hemorrhage only occurs in rare cases, and this known to have several different causes such as germ cell tumors, pineal cysts and vascular malformations, including the cavernous malformations. Pineal cavernous malformations are extremely rare: to date only fifteen cases have been reported worldwide. Although the diagnosis of pineal cavernous malformation is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. Case 1. A 42-year- old man presented with a limitation in his upward gazing. Radiologic examinations showed acute hemorrhage in the pineal region. He underwent ventriculo-peritoneal (VP) shunting but the patient's condition deteriorated after the shunting surgery. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. Case 2. A 37-year-old man presented with diplopia. Radiologic examinations showed acute hemorrhage in the third ventricle. He underwent VP shunting, and after this procedure the diplopia was aggravated. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. If there is no doubt about the pineal cavernous malformation on MR imaging, we strongly recommend early surgical intervention without performing a risky biopsy. In this study, we describe our experiences for the diagnosis of cavernous malformations in the pineal region with special emphasis on the radiological aspects and the clinical course of this disease.

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Pineocytoma With Massive Intratumoral Hemorrhage After Ventriculoperitoneal Shunt —Case Report—

Cited by 18 publications

References 11 publications

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review

Pineal Cavernous Malformations: Report of Two Cases

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