Abstract
Pineal region tumors are rare and a heterogenous group of primary central nervous system tumors which are primarily classified as germ cell tumors and non-germ cell tumors. Chemotherapy and radiotherapy as the primary treatment modalities have been reported to result in good outcomes. We discuss the case of a young girl who presented to our emergency department in an unconscious state and had a large lesion in the posterior third ventricular region, but without any associated hydrocephalus which could explain her stuporous state. Given the rapid decline in her sensorium, we were faced with the difficult choice between surgical decompression of the tumor and a trial of rescue chemotherapy following histopathological confirmation through biopsy. She underwent an open biopsy followed by chemotherapy in a neurosurgical intensive care unit despite her poor Karnofsky performance score. She improved after chemotherapy and her tumor decreased in size significantly over time. We highlight the role of chemotherapy administered in the neurosurgical ICU to an unconscious patient with a large chemoresponsive tumor leading to rapid shrinkage of the lesion and gradual improvement in the sensorium of the patient.
Similar content being viewed by others
References
Radovanovic I, Dizdarevic K, de Tribolet N et al (2009) Pineal region tumors--neurosurgical review. Med Arh 63:171–173
Fetcko K, Dey M (2018) Primary central nervous system germ cell tumors: a review and update. Med Res Arch 6:. https://doi.org/10.18103/mra.v6i3.1719
Awa R, Campos F, Arita K et al (2014) Neuroimaging diagnosis of pineal region tumors-quest for pathognomonic finding of germinoma. Neuroradiology 56:525–534. https://doi.org/10.1007/s00234-014-1369-4
Dumrongpisutikul N, Intrapiromkul J, Yousem DM (2012) Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol 33:550–555. https://doi.org/10.3174/ajnr.A2806
Shono T, Natori Y, Morioka T et al (2007) Results of a long-term follow-up after neuroendoscopic biopsy procedure and third ventriculostomy in patients with intracranial germinomas. J Neurosurg 107:193–198. https://doi.org/10.3171/PED-07/09/193
Souweidane MM, Krieger MD, Weiner HL, Finlay JL (2010) Surgical management of primary central nervous system germ cell tumors: Proceedings from the Second International Symposium on Central Nervous System Germ Cell Tumors. J Neurosurg Pediatr 6:125–130. https://doi.org/10.3171/2010.5.PEDS09112
Yang Q-Y, Guo C-C, Deng M-L et al (2016) Treatment of primary intracranial germ cell tumors: single center experience with 42 clinically diagnosed cases. Oncotarget 7:60665–60675. https://doi.org/10.18632/oncotarget.10218
Blakeley JO, Grossman SA (2006) Management of pineal region tumors. Curr Treat Options Oncol 7:505–516. https://doi.org/10.1007/s11864-006-0025-6
Quick-Weller J, Lescher S, Baumgarten P et al (2016) Stereotactic biopsy of pineal lesions. World Neurosurg 96:124–128. https://doi.org/10.1016/j.wneu.2016.04.130
Ahmed AI, Zaben MJ, Mathad NV, Sparrow OCE (2015) Endoscopic biopsy and third ventriculostomy for the management of pineal region tumors. World Neurosurg 83:543–547. https://doi.org/10.1016/j.wneu.2014.11.013
Balossier A, Blond S, Reyns N (2016) Endoscopic versus stereotactic procedure for pineal tumor biopsies: focus on overall efficacy rate. World Neurosurg 92:223–228. https://doi.org/10.1016/j.wneu.2016.03.088
Thakkar JP, Chew L, Villano JL (2013) Primary CNS germ cell tumors: current epidemiology and update on treatment. Med Oncol 30:496. https://doi.org/10.1007/s12032-013-0496-9
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
On behalf of all the contributors, the corresponding author states that there is no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Garg, K., Mishra, S., Rafiq, R. et al. Mission impossible: chemotherapy in the intensive care for pineal region germ cell tumor. Childs Nerv Syst 38, 179–183 (2022). https://doi.org/10.1007/s00381-020-05031-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00381-020-05031-5