Fatal intratumoral hemorrhage in tectal plate glioblastoma multiforme following ventriculoperitoneal shunt

Abstract

Ventriculo-peritoneal (V-P) shunting is an accepted procedure before a direct approach to large tumors producing obstructive hydrocephalus. However, it has been associated with some complications. Intratumoral hemorrhage is an uncommon but fatal complication of V-P shunt insertion. The exact mechanism of this complication is unknown, but several mechanisms have been proposed including rapid lowering of intracranial pressure following V-P shunt placement or cerebrospinal fluid (CSF) drainage and sudden decrease in CSF volume and pressure after V-P shunting. We report an 8-year-old girl who presented with severe headache, double vision, and bilateral papilledema. Brain magnetic resonance imaging with and without gadolinium administration revealed a large tectal plate tumor compressing the aqueduct which caused hydrocephalus. Due to progressive decline in consciousness level, an emergency CSF diversion was planned and she underwent left side posterior parietal V-P shunt placement. Eight hours after V-P shunt insertion, she suddenly developed tonic-clonic seizures and collapsed into deep coma with dilated pupils and stopped breathing and died 1-day later. Histological examination of the autopsy specimen showed the tumor was a glioblastoma multiforme with massive intratumoral hemorrhage. The possible pathophysiological mechanisms of this fatal complication are discussed here and the pertinent literature is reviewed. It seems that endoscopic third ventriculostomy is the procedure of choice for CSF diversion in patients with tectal plate gliomas and decreases the occurrence of intratumoral hemorrhage.

Comprehensive analysis of Iranian reports of pediatric central nervous system tumors

“…Two articles were written in Persian [8, 12], whereas the remaining 33 were written in English. Most studies (n = 27) took place in Tehran province [4–5, 8, 11–13, 15–23, 25–29, 31–37] in hospitals and centers affiliated with the three main medical universities in Tehran: Tehran University of Medical Sciences (n = 16) [4–5, 11, 13, 16–17, 19–22, 26, 28–29, 31–32, 37], Shahid Beheshti University of Medical Sciences (n = 6) [12, 15, 18, 25, 27, 34,], Iran University of Medical Sciences (n = 4) [8, 23, 35, 36], and Army University of Medical Science (n = 1) [33]. Only four articles [18, 23, 26, 34] stated that approval by an ethics committee had been obtained.…”

“…Study designs were primarily single case reports (n = 16 articles [2–4, 9, 16–17, 19–22, 24, 29, 31–32, 36–37], 19 patients) and cross-sectional studies (n = 15 articles [7–8, 10–14, 15, 18, 25–26, 28, 30, 33–34], 3,271 patients). Other study designs included cohort (n = 2 articles [23, 35], 131 patients), case series (n = 1 article [5], 7 patients), and case control (n = 1 article [27], 56 patients) (Table 1).…”

“…Of the 18 articles categorized as clinical, 13 were case reports (19 patients) [2–4, 9, 17, 19–20, 22, 24, 31–32, 36–37]; two were cross-sectional studies (98 patients); two were cohort studies (98 patients); and one was a case-control study (56 patients). Clinical case reports described the disease presentation and management for each patient.…”