AB065. Basal ganglia germ cell tumor presenting with visual loss in adult: a case report.

Abstract

Basal ganglia germ cell tumor (GCT) in an adult male is quite rare. Intracranial germ cells tumor usually occurs in the midline axis, involving pituitary, sellar region, or both. Only in rare circumstances GCTs developed in basal ganglia. In this case report, we presented a patient with a main complaint of progressive visual loss from his right eye from one year prior. He had been going to the ophthalmologist but there was no improvement. A brain magnetic resonance imaging (MRI) revealed a large left basal ganglia tumor with involvement of the hypothalamus and uncus, causing pressure on the optic and oculomotor nerve. Interestingly, the patient had no decrease in motor function. Complaints of severe headache, persistent vomiting, and decrease of vision of his left eye prompt us to conduct an urgent craniotomy tumor excision. As the patient had no motor deficit prior to surgery, we chose to do a transcortical approach through the left Kocher's point, entering the left ventricle, and accessing the tumour from the floor of the frontal horn. The surgery went uneventfully. Following the surgery the patient had no motor weakness, no complaint of headache and vomiting. The visual complaints persisted. And the pathological anatomy resulted in germinoma, in which the patient underwent radiotherapy for the follow up treatment. Basal ganglia germinoma in adult is a rare occurrence, and due to its location, the surgical approach to access the mass should be individualized in each patient. Transcortical approach from the left Kocher's point was a safe and accessible approach for our patient. As the tumor was close to important structures such as hypothalamus, thalamus, and basal ganglia, only partial excision was done.