Pineocytoma with massive intratumoral hemorrhage after ventriculoperitoneal shunt--case report

A 58-year-old male suffered a massive intratumoral hemorrhage after placement of a ventriculoperitoneal shunt before treatment for pineocytoma. At admission, he complained of headache, urinary incontinence, gait disturbance, and recent memory disturbance. His neurological examination revealed impaired memory and papilledema from hydrocephalus. Two days after the placement of the ventriculoperitoneal shunt, he suddenly became stuporous and Parinaud's sign appeared. Computed tomography showed a massive intratumoral hemorrhage occupying the third ventricle which had extended into the lateral ventricle. The infratentorial supracerebellar approach was used to remove the hematoma and the tumor. The histological diagnosis was pineocytoma. Intratumoral hemorrhage in pineocytoma after the placement of a ventriculoperitoneal shunt is rare, but should be kept in mind when a ventriculoperitoneal shunt is placed before a craniotomy.