Rare pineal tumor monitored for over 20 years without signif | Figure 1
doc_ambidexter
Neurosurgery
Rare pineal tumor monitored for over 20 years without significant size change or symptoms. Initially picked up as incidental finding. Pt abruptly decompensated and presented to ER in coma. CT revealed that vessels around the lesion had bled. No aneurysm or other vascular malformation was found. Pineal lesions can exert pressure on the 3rd ventricle causing upstream CSF blockage, in this case of the lateral ventricles. Note enlarged ventricles in the 4th image (CT). Ventricular catheter was placed to decrease ICP and divert CSF. Pt did not improve. Note that pineal lesion surgery is hazardous due to central location in the brain and "high stakes" surrounding anatomy.