Basal ganglia germinoma presenting with visual loss in male adult: A case report

TL;DR

A rare case of a germinoma in the basal ganglia of an adult male presented with visual loss and was successfully treated with a specific surgical approach.

Contribution

This is the first reported case of a basal ganglia germinoma in an adult presenting primarily with visual loss.

Findings

The patient had a germinoma in the basal ganglia with no prior motor deficits.

A transcortical approach through the left Kocher point was used successfully for tumor access.

The case highlights the rarity and unique presentation of germinomas in adults.

Abstract

Basal ganglia germ cell tumor (GCT) in an adult has been rarely reported 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.

A 27-year-old male came to our academic general hospital outpatient clinic with main complaint of progressive visual loss of his right eye which started a year ago. Despite his visits to the opthalmologist, the complaint worsen. A brain MRI revealed a large left basal ganglia tumor with involvement of the hypothalamus and uncus, causing pressure on the optic and occulomotor nerve. Interestingly, the patient had no decrease in motor function. Complaint 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 point, entering the left ventricle, and accessing the tumor from the floor of the frontal horn.

GCT is a rare and diverse group of tumors based on histology. It is more common in men and mostly affects the pediatric and adolescent populations. Usually located in the sellar or pineal regions, this tumor may infrequently spread to the basal ganglia. The gold standard for diagnosing germ cell tumors is histopathological analysis, particularly in regions of the basal ganglia with a wide range of potential aetiologies. Obtaining a biopsy sample surgically is difficult, particularly for patients whose motor function is preserved. The surgical strategy should be tailored to the patient's radiological and clinical results, ideally taking the surgeon's preferences into account as well.

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.

•Basal ganglia germinomas commonly occurs in pediatric population.•There is no prior report of this tumours developing in an adult whose main complaint is loss of vision.•Accessing the basal ganglia tumor surgically is a challenge, especially in patient with intact motor function.•Transcortical approach from the left kocher’s point was a safe and accessible approach for our patient.

Basal ganglia germinomas commonly occurs in pediatric population.

There is no prior report of this tumours developing in an adult whose main complaint is loss of vision.

Accessing the basal ganglia tumor surgically is a challenge, especially in patient with intact motor function.

Transcortical approach from the left kocher’s point was a safe and accessible approach for our patient.

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