SHUNT-RELATED ABDOMINAL METASTASIS OF CEREBRAL TERATOCARCINOMA - REPORT OF AN UNUSUAL CASE AND REVIEW OF THE LITERATURE

OBJECTIVE AND IMPORTANCE: Internal drainage of cerebrospinal fluid to the abdominal cavity via a ventriculoperitoneal shunt (VPS) is a commo n procedure for therapy of obstructive hydrocephalus; because this con dition is often caused by brain tumors blocking the natural cerebrospi nal fluid pathways, the VPS as an artificial anastomosis can provide t he means for the spreading of tumor cells by the cerebrospinal fluid. We report the case of a VPS-related abdominal metastasis of a teratoca rcinoma and review the pertaining literature. CLINICAL PRESENTATION AN D INTERVENTION: A 24-year-old man with a history of three brain tumors that were operated on when the patient was 14, 21, and 23 years of ag e developed an acute ileus 7 months after VPS insertion for cerebral t eratocarcinoma. Intraoperatively, a massive abdominal tumor was observ ed, which turned out to be a peritoneal metastasis of the aforesaid br ain tumor. The patient died as a result of his illness 1 month later. RESULTS: To date, 58 VPS-related metastases of brain tumors have been described. The male-to-female ratio is 1.6:1, the mean age at shunt in sertion is 12.2 years, and the interval between shunt operation and di agnosis of metastases is 16.8 months. During the observation time, 69. 2% of the patients died as a result of their illness or abdominal meta stases. The most common sources of the metastases were germinomas (27. 7%), medulloblastomas (19.1%), and endodermal sinus tumors (10.3%). CO NCLUSION: The presented case is only the second VPS-related abdominal spreading of a cerebral teratocarcinoma. Metastases via VPS are rare b ut should be considered as a possible complication and mode of systemi c spread in patients with primary intracranial malignancy.