Minim Invasive Neurosurg 2006; 49(2): 116-119
DOI: 10.1055/s-2006-932180
Original Article
© Georg Thieme Verlag Stuttgart · New York

Management of Intracranial Germ Cell Tumors Presenting with Rapid Deterioration of Consciousness

H.  Nishioka1 , J.  Haraoka1 , T.  Miki1
  • 1Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan
Further Information

Publication History

Publication Date:
18 May 2006 (online)

Abstract

Objectives: The value of surgical intervention in the management of intracranial germ cell tumors remains controversial. Patients: We report three patients who presented with rapid deterioration of consciousness but resulted in complete remission of the tumor after emergency surgery for both diagnostic (biopsy) and therapeutic (for hydrocephalus) purposes followed by prompt initiation of radiochemotherapy. Conclusion: For management of these rapidly deteriorating patients, immediate histological verification and avoidance of delay in the induction of radiochemotherapy are essential. Thus, emergency surgery with a less invasive procedure is the first choice of treatment, i. e., endoscopic surgery for pineal region tumor and CT-guided biopsy for basal ganglia tumor.

References

  • 1 Matsutani M, Ushio Y, Abe H, Yamashita J, Shibui S, Fujimaki T, Takakura K, Nomura K, Tanaka R, Fukui M, Yoshimoto T, Hayakawa T, Nagashima T, Kurisu K, Kayama T. Combined chemotherapy and radiation therapy for central nervous system germ cell tumors: preliminary results of a phase II study of the Japanese Pediatric Brain Tumor Study Group.  Neurosurg Focus. 1998;  5 article 7
  • 2 Matsutani M. [Germ cell tumor.] In: Takakura K, Yamaura A (eds). New Lecture 3. Noushuyo, 2nd edn. Tokyo: Shinohara 1996: 281-303
  • 3 Matsutani M, Sano K, Takakura K, Fujimaki T, Nakamura O, Funata N, Seto T. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases.  J Neurosurg. 1997;  86 446-455
  • 4 Packer R J, Cohen B H, Coney K. Intracranial germ cell tumors.  Oncologist. 2000;  5 312-320
  • 5 Balmaceda C, Heller G, Rosenblum M, Diez B, Villabranca J G, Kellie S, Maher P, Vlamis V, Walker R W, Leibel S, Finlay J L. Chemotherapy without irradiation - a novel approach for newly diagnosed CNS germ cell tumors: results of an international cooperative trial.  J Clin Oncol. 1996;  14 2908-2915
  • 6 Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumia J. Neuroendoscopic management of pineal region tumours.  Acta Neurochir (Wien). 1997;  139 12-21
  • 7 Jaing T-H, Wang H-S, Hung I-J, Tseng C-K, Yang C-P, Hung P-C, Lui T-N. Intracranial germ cell tumors: a retrospective study of 44 children.  Pediatr Neurol. 2002;  26 369-373
  • 8 Janmohamed S, Grossman A B, Metcalfe K, Lowe D G, Wood D F, Chew S L, Monson J P, Besser G M, Plowman P N. Suprasellar germ cell tumours: specific problems and the evolution of optimal management with a combined chemoradiotherapy regimen.  Clin Endocrinol. 2002;  57 487-500
  • 9 Linstadt D, Wara W M, Edwards M SB, Hudgins R J, Sheline G E. Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation.  Int J Radiat Oncol Biol Phys. 1998;  15 291-297
  • 10 Nishizaki T, Kajiwara K, Adachi N, Tsuha M, Nakayama H, Ohshita N, Ikeda N, Iwamoto N, Ito H, Suzuki M. Detection of craniospinal dissemination of intracranial germ cell tumours based on serum and cerebrospinal fluid levels of tumour markers.  J Clin Neurosci. 2001;  8 27-39
  • 11 Oi S, Shibata M, Tominaga J, Honda Y, Shinoda M, Takei F, Tsugane R, Matsuzawa K, Sato O. Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospectively study.  J Neurosurg. 2000;  93 245-253
  • 12 Liang L, Korogi Y, Sugahara T, Ikushima I, Shigematsu Y, Okuda T, Takahashi M, Kochi M, Ushio Y. MRI of intracranial germ-cell tumours.  Neuroradiol. 2002;  44 382-388
  • 13 Miki T, Ito H, Wada J, Hashimoto T. [Neuroendoscopic treatment of pineal region tumors.]  Nerv Sys Child. 1998;  23 323-331
  • 14 Pople I K, Athanasiou T C, Sandeman D R, Coakham H B. The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours.  Br J Neurosurg. 2001;  15 305-311

Hiroshi Nishioka,M. D. 

Department of Neurosurgery · Tokyo Medical University

6-7-1 Nishishinjuku

Shinjuku-ku

Tokyo 160-0023

Japan

Phone: +81/3/3342/6111 (ext. 5773)

Fax: +81/3/3340/4285 ·

Email: nishioka@tokyo-med.ac.jp

    >