Pineal region tumors are rare and a heterogenous group of primary central nervous system tumors which are primarily classified as germ cell tumors and non-germ cell tumors. Chemotherapy and radiotherapy as the primary treatment modalities have been reported to result in good outcomes. We discuss the case of a young girl who presented to our emergency department in an unconscious state and had a large lesion in the posterior third ventricular region, but without any associated hydrocephalus which could explain her stuporous state. Given the rapid decline in her sensorium, we were faced with the difficult choice between surgical decompression of the tumor and a trial of rescue chemotherapy following histopathological confirmation through biopsy. She underwent an open biopsy followed by chemotherapy in a neurosurgical intensive care unit despite her poor Karnofsky performance score. She improved after chemotherapy and her tumor decreased in size significantly over time. We highlight the role of chemotherapy administered in the neurosurgical ICU to an unconscious patient with a large chemoresponsive tumor leading to rapid shrinkage of the lesion and gradual improvement in the sensorium of the patient.

松果体区肿瘤是一种罕见的异质原发性中枢神经系统肿瘤，主要分为生殖细胞肿瘤和非生殖细胞肿瘤。据报道，化疗和放疗作为主要治疗方式可产生良好的效果。我们讨论了一个年轻女孩的案例，她在无意识状态下到我们的急诊室就诊，第三脑室后部区域有一个大损伤，但没有任何相关的脑积水可以解释她的昏迷状态。鉴于她的感觉中枢迅速下降，我们面临着在肿瘤手术减压和活检组织病理学确认后尝试挽救化疗之间的艰难选择。尽管她的 Karnofsky 表现评分很差，但她在神经外科重症监护病房接受了开放式活检和化疗。化疗后她的病情有所好转，随着时间的推移，她的肿瘤明显缩小。我们强调了在神经外科 ICU 中对无意识患者进行化疗的作用，该患者患有大的化疗反应性肿瘤，导致病灶迅速缩小并逐渐改善患者的感觉。