A rare case of pineal astrocytoma with hemorrhagic changes: Diagnostic and surgical challenges

Pineal astrocytoma is an uncommon central nervous system tumor, presenting diagnostic and therapeutic challenges due to its deep-seated location and nonspecific clinical features. This case report describes a 37-year-old female who presented with altered sensorium, persistent headache, and projectile vomiting for 20 days. Initial examination revealed stable vitals and a reduced Glasgow Coma Scale score, necessitating immediate intubation. Magnetic resonance imaging (MRI) of the brain revealed a solid-cystic lesion in the pineal region with intraventricular extension, mass effect on the midbrain, and hemorrhagic changes. Magnetic resonance spectroscopy (MRS) findings, including elevated choline and lipid peaks with reduced N-acetyl aspartate, suggested a neoplastic etiology. The patient underwent a suboccipital craniotomy via a supracerebellar infratentorial approach for partial tumor excision. Histopathological analysis confirmed the lesion as a grade IV astrocytoma. Postoperative recovery was stable, and further management with adjuvant radiotherapy and chemotherapy was planned due to the high-grade nature of the tumor. This case highlights the importance of integrating clinical findings, advanced imaging techniques, and histopathological evaluation to accurately diagnose and manage rare pineal region tumors. Despite surgical intervention, the prognosis for high-grade astrocytomas remains poor, underscoring the necessity for continued research into targeted therapies and novel treatment approaches.