Fatal intratumoral hemorrhage in pineal tumors following cerebrospinal fluid diversion

We report two patients with massive intratumoral hemorrhage in pineal tumors. A 23-year-old male with pineocytoma, whose (MRI, CT) image demonstrated obstructive hydrocephalus, was subjected to a right ventriculoperitoneal shunt. His consciousness deteriorated, and he experienced massive intratumoral hemorrhage and later died. Another case of pineal tumor was a 47-year-old male who underwent emergency external ventricular drainage for associated obstructive hydrocephalus and deteriorating consciousness. He had a sudden deterioration following the procedure and imaging revealed massive intratumoral hemorrhage. He remained vegetative at discharge and died 2 weeks later. Although Intratumoral hemorrhage in pineocytoma after the placement of a ventriculoperitoneal shunt or external ventricular drainage is rare, it is an important cause of morbidity and mortality and should be kept in mind when cerebrospinal fluid (CSF) diversion was conducted before a craniotomy.