Skip to main content
  • Seeding of Abdomen with Primary Intracranial Hemangiopericytoma by a Ventriculoperitoneal Shunt: Case Report

    Final Number:

    Kelly Bridges MD; Hai Sun MD PhD; Ahmed M. Raslan MBBS, MCh; Sauerwein Rebecca

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: It has been reported that neurosurgical procedures including ventriculoperitoneal shunt (VPS) placement are implicated in extraneural metastasis of primary intracranial tumors. Reported cases include, but are not limited to, medulloblastoma, germ cell tumor, astrocytoma, oligodendroglioma, lymphoma, ependymoma, melanoma, and choroid plexus tumors. However, from the author’s review of the literature, there has been no reported case of extraneural metastasis of hemangiopericytoma (HPC), until now.

    Methods: The authors report a case of an intracranial malignant hemangiopericytoma where the presence of a VPS may have been the culprit for two subsequent abdominal metastases.

    Results: A 46-year-old gentleman with recurrent intracranial HPC underwent surgical tumor resection and subsequent placement of a VPS for obstructive hydrocephalus in 2004. He presented in 2011 and again in 2013 with abdominal HPC metastasis likely caused by the presence of his VPS.

    Conclusions: This case raises concern regarding placement of a VPS in patients with obstructive hydrocephalus caused by HPC. To avoid spread of HPC to the abdomen, we propose that patients with intracranial HPC and obstructive hydrocephalus be treated primarily by endoscopic third ventriculostomy.

    Patient Care: If endoscopic third ventriculostomy serves as a successful treatment option for tumor-related hydrocephalus, then this can decrease incidence of extraneural metastases, and hopefully prolong life.

    Learning Objectives: By the conclusion of this session, participants should be able to 1) Describe the importance endoscopic third ventriculostomy and tumor-related hydrocephalus, 2) Discuss in small groups alternative options for preventing extraneural metastases, 3) Identify risk factors for extraneural metastases

    References: Lee M and Lee J. Malignant Ascites after Subduroperitoneal Shunt in a Patient with Leptomeningeal Metastasis. Journal of Korean Neurosurgical Society. Oct, 2011. 50(4): 385-387 Pettersson D, et al. Medulloblastoma: seeding of VP shunt tract and peritoneum. Clinics and Practice. March, 2012. 2(2): e37 Magtibay P, et al. Unusual presentation of adult metastatic peritoneal medulloblastoma associated with a ventriculoperitoneal shunt: A case study and review of the literature. Neuro-Oncology. July, 2003. Jimenez-Jimenz. Extraneural metastases from brainstem astrocytoma through ventriculoperitoneal shunt. Journal of Neurology, Neurosurgery, & Psychiatry. March, 1991. 54(3): 281-282 Loiacono et al. Abdominal metastases of medulloblastoma related to a ventriculoperitoneal shunt. American Journal of Roentgenology. 2005. 186: 1548-1550 Mori T, et al. Medulloblastoma with intractable ascites treated by carboquone – a complication of a ventriculoperitoneal shunt. No Shinkei Geka 1977. 5: 1299-1303 Shibasaki T, et al. Extraneural metastases of malignant brain tumors through ventriculo-peritoneal shunt. Report of two autopsy cases and review of the literature. Neurosurgery (Tokyo) 1977. 5:71-79 Becker H, et al. Extraneural metastases in Oligodendroglioma due to ventriculoperitoneal shunt. Oncology. 1978. 1:216-220 Neuwelt E, et al. Malignant pineal region tumors. Journal of Neurosurgery. 1979. 51: 597-607 Oberbauer RW, et a. Shunt metastases in posterior fossa tumors. Neuropadiatrie. 1979. 10:296-300 Wood BP, et al. Shunt metastases of pineal tumors presenting as a pelvic mass. Pediatric Radiology. 1979. 8:108-109 Trigg ME, et al. Metastasis of an optic glioma through a ventriculoperitoneal shunt. Cancer. 1983. 51:599-601 Nishio S, et al. Anaplastic evolution of childhood optico-hypothalamic pilocytic astrocytoma: report of an autopsy case. Clinical Neuropathology. 1988. 7: 254-258 Pfletschinger J, et al. Metastases peritoneales d’un pinealoblastome chez une patiente porteuse d’une derivation ventriculo-peritoneale. Pediatrie. 1986. 41: 231-236 Newton HB, et al. Extraneural metastases of infratentorial glioblastoma multiforme to the peritoneal cavity. Cancer. 1992. 69: 2149-2153 Pollack IF, et al. Dissemination of low grade intracranial astrocytomas in children. Cancer. 1994. 73: 2869-2878 Gattuso P, et al. Peritoneal implantation of meningeal melanosis via ventriculoperitoneal shunt: a case report and review of the literature. Diagnostic Cytopathology. 1995 13: 257-259 Rickert CH. Abdominal metastases of pediatric brain tumor via ventriculoperitoneal shunt. Child’s Nervous System. 1998; 14:10–14 Fiorillo A, et al. Shunt related abdominal metastases in an infant with medulloblastoma: Long term remission by systemic chemotherapy and surgery. Jounral of Neuro-Oncology. 2001. 52: 273-726 Kun, et al. Primary Cerebral Germinoma and Ventriculoperitoneal Shunt Metastasis. Cancer. 1981. 48:213-216 Haimovic I, et al. Metastasis of Intracranial Germinoma Through a Ventriculoperitoneal Shunt. Cancer. 1981. 48: 1033-1036 Lewis MB, et al. Extra-axial spread of medulloblastoma. Cancer. 1973. 31: 1287–1297. 1. Hoffman HJ, Duffner PK. Extraneural metastases of central nervous system tumors. Cancer. 1985;56(7 Suppl):1778-1782. 2. Donovan DJ, Prauner RD. Shunt-related abdominal metastases in a child with choroid plexus carcinoma: case report. Neurosurgery. 2005;56(2):E412; discussion E412. 3. Mena H, Ribas JL, Pezeshkpour GH, Cowan DN, Parisi JE. Hemangiopericytoma of the central nervous system: a review of 94 cases. Hum. Pathol. 1991;22(1):84-91. 4. Melone AG, D'Elia A, Santoro F, et al. Intracranial hemangiopericytoma--our experience in 30 years: a series of 43 cases and review of the literature. World Neurosurg. 2014;81(3-4):556-562. 5. Damodaran O, Robbins P, Knuckey N, Bynevelt M, Wong G, Lee G. Primary intracranial haemangiopericytoma: Comparison of survival outcomes and metastatic potential in WHO grade II and III variants. J. Clin. Neurosci. 2014. 6. Ding D, Sheehan JP. Intracranial Hemangiopericytomas: A Wolf in Sheep's Clothing. World Neurosurg. 2014. 7. Brat DJ, Parisi JE, Kleinschmidt-DeMasters BK, et al. Surgical neuropathology update: a review of changes introduced by the WHO classification of tumours of the central nervous system, 4th edition. Arch. Pathol. Lab. Med. 2008;132(6):993-1007. 8. Bastin KT, Mehta MP. Meningeal hemangiopericytoma: defining the role for radiation therapy. J. Neurooncol. 1992;14(3):277-287. 9. Ramos LR, Marques PP, Loureiro R, Brito MJ, de Freitas J. Pancreatic metastasis of a meningeal hemangiopericytoma: a rare cause of obstructive jaundice. Endoscopy. 2014;46 Suppl 1 UCTN:E135-136. 10. Hiraide T, Sakaguchi T, Shibasaki Y, et al. Pancreatic metastases of cerebellar hemangiopericytoma occurring 24 years after initial presentation: report of a case. Surg. Today. 2014;44(3):558-563. 11. Koyama H, Harada A, Nakao A, et al. Intracranial hemangiopericytoma with metastasis to the pancreas. Case report and literature review. J. Clin. Gastroenterol. 1997;25(4):706-708.

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy