Cervical spinal cord infarction after surgery for a pineal region choriocarcinoma in the sitting position: Case report

OBJECTIVE AND IMPORTANCE: Spinal cord injury is one of several devastating complications after operation in the sitting position. Young patients exhibiting extraordinary growth spurts demonstrate a higher risk for this complication. CLINICAL PRESENTATION: We describe a 7-year-old male patient with a pineal region choriocarcinoma in whom a cervical spinal cord infarction (C5-T1) developed as an acute complication after operation in the sitting position. Preoperatively, high serum levels of human chorionic gonadotropin (5867.7 mIU/ml) and somatomedin-C (704 ng/ml) and an extreme growth velocity in height (16 cm/yr) were noted. CONCLUSION: It is assumed that, in addition to head flexion, the abnormal skeletal growth spurt resulting from an excessive secretion of human chorionic gonadotropin from a tumor was a possible predisposing factor for this complication. To prevent this complication, surgeons need to pay great attention to head positioning, especially in a young patient experiencing an active growth spurt.