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Abstract: A 26-year-old young man was admitted to the hospital with a complaint of visual double vision for 1 month. The patient started to have visual double vision with blurred vision for 1 month before admission without any obvious cause. After completing relevant examinations, he was initially diagnosed with pineal cell tumor, also known as pineal tumor, and was admitted to the hospital and treated with standard surgery.
Basic information】Male, 26 years old
Disease Type】Pineal cell tumor
Hospital】Liaoning Provincial People’s Hospital
Date of consultation】June 2020
Treatment plan】Surgical treatment (ventriculo-abdominal shunt + pineal tumor resection) + oral medication (Olacitane capsules, cefuroxime tablets)
Treatment period】2 months of treatment, 1 month of outpatient follow-up
Treatment effect】Significant relief of hydrocephalus symptoms
I. Initial consultation
The patient was admitted to the hospital with the complaint of double vision for one month. One month before admission, the patient started to have double vision with blurred vision without any obvious cause. The head CT examination showed hydrocephalus and pineal occupancy lesion, and later the enhanced MRI of the head showed suspicion of pineal cell tumor, and the patient was admitted to the hospital. The patient had no convulsions or coma, no incontinence, free eye movement, no uveitis, and no uveitis.
II. Treatment history
After admission, the patient’s headache progressively worsened, his mental status gradually deteriorated, and he became drowsy. The patient’s family was informed that a tumor had grown in the pineal region of the skull, and because of the occupying effect of the tumor, the cerebrospinal fluid circulation pathway was obstructed, resulting in acute hydrocephalus, and the patient became acutely cranial hypertensive and became poorly conscious, requiring emergency surgery to perform ventriculo-abdominal shunt. The ventriculo-abdominal shunt was performed that night, and the intraoperative ventricular puncture tube showed that the patient had high cerebral pressure. One month after the ventriculo-abdominal shunt surgery, the patient was operated for pineal cell tumor resection to contact the pressure occupancy phenomenon.
III. Treatment results
After the patient underwent ventriculo-abdominal shunt, the cerebrospinal fluid that could not flow due to tumor compression could flow into the abdominal cavity along the drainage tube and be absorbed by the large omentum of the abdominal cavity to achieve the purpose of relieving cranial hypertension. About 14 days after the operation, the patient’s mental status improved significantly, headache was significantly reduced, no nausea and vomiting, clear speech, reasonable questions and answers, and the limbs moved freely.
About 1 month after the operation, the patient underwent the second operation again to remove the pineal cell tumor, and the pineal occupancy was relieved. 7 days after the operation, the patient recovered well and was discharged from the hospital. 2 months later, the patient was re-examined and no tumor recurrence occurred, and the patient basically resumed normal life and work.
IV. Notes
We are glad that the patient’s symptoms are relieved after treatment, but we need to remind the patient to pay attention to observe whether symptoms such as double vision, blurred vision, dizziness, headache, nausea, vomiting, etc. occur again after discharge from the hospital.
In addition, pay attention to a light and easy-to-digest diet in daily life, reduce the intake of spicy and stimulating or cold food, pay attention to strengthening nutrition, a balanced mix of various nutrients, pay attention to reasonable rest, avoid staying up late, exertion and heavy physical labor, and maintain an optimistic state of mind, which can help control the stability of the disease and promote the early recovery of the body.
V. Personal insight
Some intracranial tumors are more likely to occur in young people, so when discomfort occurs in the head and lasts for a long time, try to go to the local hospital for head CT examination. In this case, the patient went to the local hospital only one month after the discomfort occurred. When the tumor was found, the symptoms of hydrocephalus were already serious, so the patient could only undergo ventriculo-abdominal shunt surgery first.