title: Intraoperative hemorrhage in medulloblastoma: a case report and review of the literature.
abstract: OBJECTIVE
  We present the first case of intraoperative hemorrhage in a medulloblastoma.
  
  
  METHODS
  A 10-year-old girl presented with a 4-week history of headache, nausea, and vomiting. Radiological examination showed a space-occupying mass in the cerebellar vermis. Surgical removal was performed via a midline suboccipital approach. When the dura was incised and the occipital sinus was ligated after suboccipital craniectomy, bleeding occurred in the tumor. Macroscopically, hematoma was found only in the left part of the tumor and not in the right part. Microscopically, different architectures of tumor vessels, thin-walled and thick-walled, were found between the left part and the right part, respectively. The tumoral contents and hematoma were totally removed. Histological examination revealed a medulloblastoma.
  
  
  CONCLUSIONS
  We experienced a very rare case of medulloblastoma in which intratumoral hemorrhage occurred during operation. We speculate that ligation of the occipital sinus and thin-walled vessels within the tumor might have caused the hemorrhage in our case.
authors.affiliation: Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama City, 641-0012 Japan. jun-fukai461111@est.hi-ho.ne.jp
authors.forename: Junya
authors.initials: J
authors.lastname: Fukai
authors.forename: Yuji
authors.initials: Y
authors.lastname: Uematsu
authors.forename: Aki
authors.initials: A
authors.lastname: Shintani
authors.forename: Kunio
authors.initials: K
authors.lastname: Nakai
authors.forename: Toru
authors.initials: T
authors.lastname: Itakura
mesh_terms: D002528:Cerebellar Neoplasms / Q000473:pathology / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000209:etiology*; D002648:Child; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000473:pathology / Q000601:surgery*; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014057:Tomography, X-Ray Computed