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An unusual case of primary central nervous system germinoma with meningeal dissemination

Yasuhiro Takeshima1, Shuichi Yamada, Yasushi Motoyama

  • 1Department of Neurosurgery, Nara Medical University School of Medicine, 840 Shijo-cho, Kashihara, Nara 634-8521, Japan. takeshim@naramed-u.ac.jp

Child'S Nervous System : Chns : Official Journal of the International Society for Pediatric Neurosurgery
|September 1, 2012
PubMed
Abstract

Insights

Primary central nervous system germinoma with meningeal dissemination is rare. This case highlights the importance of considering wider irradiation for potential subdural spread in germinoma patients.

Area of Science:

  • Neuro-oncology
  • Neurosurgery
  • Pediatric Oncology

Background:

  • Central nervous system (CNS) germinomas typically spread within the cerebrospinal fluid pathways.
  • Meningeal dissemination is an uncommon presentation for primary CNS germinomas.

Observation:

  • A 16-year-old male presented with symptoms of anorexia and headache.
  • Radiological imaging revealed a posterior fossa mass, a pineal lobule lesion, and thickening of the tentorium cerebelli and falx.
  • Intraoperative findings confirmed dural and supracerebellar mass extension into the epiarachnoid space.

Findings:

  • The patient underwent surgical debulking followed by adjuvant chemotherapy (ifosfamide, etoposide, cisplatin) and craniospinal irradiation.
  • The treatment regimen resulted in a complete response.

Implications:

  • CNS germinoma cells may adhere to meningeal surfaces, similar to their affinity for cerebrospinal fluid.
  • Consideration of comprehensive post-diagnostic irradiation is crucial for potential subdural extension during surgical or other interventions.

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