title: Management of intracranial germ cell tumors presenting with rapid deterioration of consciousness.
abstract: OBJECTIVE
  The value of surgical intervention in the management of intracranial germ cell tumors remains controversial.
  
  
  METHODS
  We report three patients who presented with rapid deterioration of consciousness but resulted in complete remission of the tumor after emergency surgery for both diagnostic (biopsy) and therapeutic (for hydrocephalus) purposes followed by prompt initiation of radiochemotherapy.
  
  
  CONCLUSIONS
  For management of these rapidly deteriorating patients, immediate histological verification and avoidance of delay in the induction of radiochemotherapy are essential. Thus, emergency surgery with a less invasive procedure is the first choice of treatment, i. e., endoscopic surgery for pineal region tumor and CT-guided biopsy for basal ganglia tumor.
authors.affiliation: Department of Neurosurgery, Tokyo Medical University, Tokyo, Japan. nishioka@tokyo-med.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Nishioka
authors.forename: J
authors.initials: J
authors.lastname: Haraoka
authors.forename: T
authors.initials: T
authors.lastname: Miki
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications / Q000556:secondary / Q000601:surgery*; D002648:Child; D003244:Consciousness Disorders / Q000209:etiology*; D018240:Endodermal Sinus Tumor / Q000150:complications / Q000473:pathology / Q000601:surgery*; D018237:Germinoma / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008297:Male; D018239:Seminoma / Q000150:complications / Q000556:secondary / Q000601:surgery*; D013736:Testicular Neoplasms / Q000473:pathology; D013997:Time Factors