(Disclaimer: This article is for popularization purposes only. In order to protect patients’ privacy, the information in the following content has been processed) Abstract: The presence of headache, vomiting with epiphora is often a cause for alarm for the presence of pineal tumors. In this case, the patient came to our hospital because of recurrent dizziness and headache, and complained of intermittent nausea during fasting, accompanied by poor appetite, repeated vomiting after eating, and weakness of the limbs, and was diagnosed with pineal tumor after examination, and the patient’s condition was obviously controlled through surgical treatment and chemotherapy, and the symptoms of dizziness and headache were relieved. Basic information] Male, 20 years old [Disease type] Pineal body tumor [Hospital] Shanghai First People’s Hospital [Time of consultation] May 2022 [Treatment plan] Stage I ventricular drainage + Stage II pineal tumor biopsy (intraoperative freezing) + Stage III ventriculoperitoneal shunt + Stage IV oncology radiotherapy [Treatment cycle] 18 days of hospitalization, and every three months for review [Treatment effect] The condition has been obviously controlled, and all indicators have improved. The patient complained of headache, stuffy pain, distension, intermittent nausea and poor appetite during fasting, nausea worsened after eating and vomiting, which was in the form of jet, combined with weakness of the limbs. In addition, the patient reported that he had difficulty in upturning both eyes, and the upturned visual field decreased compared with before, but there was no significant change in visual acuity. Based on the patient’s symptoms, the presence of intracranial hypertension was initially considered, and an emergency CT examination was performed, which suggested that the patient had a round-like lesion with uneven density and calcification in the pineal region, which was combined with an enlarged supratentorial ventricle, and was diagnosed as a pineal tumor. Communication with the patient made it clear that the intracranial space and hydrocephalus required late surgical treatment, and the patient agreed to undergo surgery, so the patient was admitted to the ward for further treatment. After admission, the patient underwent further examination, and the results of enhanced magnetic resonance examination suggested that the pineal region had obvious occupational enhancement and rich blood supply. In view of the fact that the incidence of germ cell tumors is the highest among pineal region tumors, the patient was tested for germ cell tumor-related protein indicators in blood and cerebrospinal fluid, such as human chorionic gonadotropin β-HCG and alpha-fetoprotein AFP, but the results were negative. Subsequently, the patient was given mannitol injection to reduce intracranial pressure by dehydration, and after intravenous infusion, the patient’s conscious nausea and vomiting symptoms were relieved, but not completely controlled, and then the patient was considered to control the symptoms by first ventricular external drainage under stage I emergency. After the operation, the patient’s headache, nausea and vomiting symptoms were significantly relieved, and with the improvement of various laboratory results, the patient was planned to undergo phase II surgery. We discussed with the patient’s family and informed them that a biopsy of the lesion should be performed first to clarify the general type of pathology. If it was suggested that the tumor was a germ cell tumor that was more sensitive to radiotherapy, there was no need to expand the resection of the tumor, and radiotherapy and adjuvant chemotherapy could be performed at a later stage. If it is not a germ cell tumor, then an extended complete resection is required, which the family said is reasonable. When the stage II surgery was performed, intraoperative freezing suggested malignant tumor, which was considered to be germ cell tumor, so we stopped the continuation of extended resection. As the tumor was only biopsied, the cerebrospinal fluid circulation was still blocked, and the extraventricular drainage tube in stage I was left in place for too long, which was prone to secondary intracranial infections. Therefore, after making sure that the cerebrospinal fluid test was not abnormal, the drainage tube in stage I was removed, and ventriculoperitoneal shunt was carried out in stage III, and the patient was advised to go to the Department of Oncology to have the corresponding radiotherapy after the operation. After a series of treatment and surgery, the patient’s symptoms of dizziness, headache, nausea and vomiting were significantly relieved, and the symptoms of epiphora were slightly relieved. Through imaging observation, there was no obvious blood seepage in the operation area, and the cerebrospinal fluid test was not abnormal, and there was no intracranial infection; meanwhile, the ventriculo-peritoneal shunt tube was fluent and in place, and the size of the brain ventricle was reduced compared with the previous one, and hydrocephalus was significantly improved compared with that of the previous one, so that the overall condition was under obvious control, and all the indicators were improved. All indicators improved. The patient was discharged on the 18th day of hospitalization. The patient was discharged on the 18th day of hospitalization and was instructed to undergo cranial and cerebral enhancement MRI every 3 months. After a series of treatments, the patient’s condition was obviously controlled. It is recommended that the patient should continue to go to the Department of Oncology for radiotherapy in order to further eliminate the germ cell tumor. After being discharged from the hospital, the patient should undergo cranial and cerebral enhancement MRI every 3 months to observe the change of the tumor size and to clarify whether there is any recurrence, and at the same time to observe the change of the hydrocephalus ventricle, if the ventricle becomes bigger again or the symptom of intracranial hypertension occurs, it is necessary to come to the hospital for consultation and treatment at any time. It is recommended that the patient press the shunt pump 50 times a day in the morning, noon and night to prevent the shunt tube from blocking. Meanwhile, the patient’s temperature should be closely monitored daily, and if the temperature exceeds 37.5℃ for 3 consecutive days, the patient should come to the hospital to find out the cause of the fever in a timely manner. V. PERSONAL INSIGHTS Pineal tumors encompass a range of tumor types that grow in the pineal region, most of which are malignant, with only a few, such as pineal cell tumors, benign teratomas, and cholesteatomas, being benign. In addition to causing intracranial hypertension, this disease can also compress adjacent tissues such as tetralogy of Fallot, thalamus, cerebellum and brainstem, causing symptoms such as ocular motility disorders, vision loss, hearing loss, ataxia, motoneural paralysis, and precocious puberty, etc. Therefore, when encountering patients with symptoms similar to the above mentioned symptoms, we need to be vigilant against the possibility of pineal gland tumors. In addition, it should be noted that the most common type of pineal tumor is germ cell tumor, which is sensitive to radiotherapy. If the germ cell tumor-related proteins such as β-HCG and AFP in blood and cerebrospinal fluid are obviously elevated, radiotherapy and adjuvant chemotherapy can be carried out directly without biopsy. In this case, the above indicators were normal, so biopsy was needed to clarify the pathology and then radiotherapy was performed.