Reverse Herniation of Brain: A Less Recognized Complication in a Patient With Midline Posterior Fossa Tumor Postendoscopic Third Ventriculostomy

Delayed intra-tumoural haemorrhage in pineal germinoma: Case report and review

“…Proposed pathophysiological mechanisms implicate the acute reduction of CSF pressure in one ventricular compartment resulting in an increased transmural pressure gradient across the tumour, with progressive distortion of fragile tumour vessels. Resultant tumour movement may further compress venous drainage leading to venous hypertension, increased tumour oedema and spontaneous parenchymal haemorrhage [12,20]. All clinically relevant tumour haemorrhages reported have occurred by Day 2, which is consistent with the proposed mechanism of haemorrhage secondary to acute changes in intracranial pressure (ICP).…”

Reverse brain herniation following ventriculoperitoneal shunt

“…Cases reported later in the literature had a better outcome. [245] In about 25% of the patients, ventricular drainage is directly responsible for precipitation of the herniation. Hence, patients who undergo CSF diversion should be observed closely for neurological deterioration postoperatively.…”

Endoscopic Third Ventriculostomy before Posterior Fossa Tumor Surgery in Adult Patients

“…17 Upward herniation and intratumoral bleeding are complications more associated with overdrainage after shunting or EVD, but they have been also described after ETV. 5,18,19 Risk Factors of Failure of an ETV before Posterior Fossa Tumor Surgery in Adults…”