Wibowo Riky Novriansyah, Suryaningtyas Wihasto, Parenrengi Muhammad Arifin
Department of Neurosurgery, Dr. Soetomo General Hospital/Faculty of Medicine, Airlangga University, Surabaya, East Java, Indonesia.
Surg Neurol Int. 2024 Nov 29;15:438. doi: 10.25259/SNI_690_2024. eCollection 2024.
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.
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.
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.
松果体区肿瘤在成人中枢神经系统肿瘤中占0.4%，在19岁以下儿童中占2.8%。松果体肿瘤具有组织学变异性，需要多学科方法处理。治疗脑积水的第一步是采用内镜下第三脑室造瘘术（ETV）或分流手术。
我们报告一例松果体区巨大肿瘤内出血的儿童病例。一名8岁男孩，松果体区疑似生殖细胞瘤伴梗阻性脑积水，接受了右脑室腹腔分流术。术后他突然意识下降。随后的影像学检查显示脑室内广泛的高密度病变，提示肿瘤内出血。鉴于脑室腹腔分流术后松果体细胞瘤内出血并不常见，这是导致发病率和死亡率的一个重要因素。在开颅手术前行脑脊液（CSF）分流时应予以考虑。
一种假说认为，尽管罕见，但CSF分流后CSF流动的改变可能是肿瘤内出血的主要触发因素。在本研究中，我们介绍了我们患者的经验，并对现有文献进行了全面评估。
