Concurrent surgical management of pineoblastoma and Chiari type 1.5 malformation: a case report

Pineoblastoma, a highly aggressive embryonal tumor predominantly affecting the pediatric population, poses significant therapeutic challenges. Current treatment modalities typically involve a combination of surgical resection, chemotherapy, and radiotherapy. While the clinical presentation of pineoblastoma is well-documented, its association with other neurological conditions, particularly Chiari malformations, remains exceedingly rare.

This report presents a unique case of a 17-year-old male patient diagnosed with both pineoblastoma and Chiari type 1.5 malformation. The patient presented with headache as the sole complaint. Neurological examination revealed nystagmus, quadriparesis, restricted ocular motility in the right eye, and cerebellar signs including a positive Romberg test, dystonia, and dysmetria. Notably, the patient had no history of radiation exposure or known genetic predisposition.

This case marks the initial reported occurrence of concurrently managing a Chiari malformation while surgically removing a pineal region tumor to create a wider and safer surgical corridor. Our combined approach allowed safe and effective tumor resection while optimizing surgical exposure. It may serve as a useful reference for surgeons facing similar complex pathologies.