Case Report: Third Ventricle Multiloculated Cystic Mature Teratoma with Intraoperative Massive Bleeding

<ns3:p>Intracranial teratomas are rare central nervous system germ cell tumors, and their occurrence within the third ventricle of pediatric patients presents significant surgical challenges owing to the proximity of critical neurovascular structures. We report the case of an 8-year-old boy who presented with hydrocephalus and seizures caused by a large multiloculated cystic and solid mass in the third ventricle. An initial attempt at gross total resection via a transcortical transventricular approach was complicated by a massive, life-threatening hemorrhage upon dissection of the tumor from the ventricular floor, which was suspected to be an injury to the internal cerebral vein. The procedure was aborted, and bleeding was controlled with hemostatic packing. After a 10-day period of stabilization in the pediatric intensive care unit, the patient underwent a second craniotomy to remove the packing and resect the tumor. Histopathological analysis confirmed the diagnosis of mature teratoma. Postoperatively, the patient required a new ventriculoperitoneal shunt to treat persistent hydrocephalus and residual left-sided hemiparesis. This case highlights the profound risk of vascular injury during resection of large intraventricular teratomas. It also demonstrates that a staged surgical approach can be a crucial life-saving strategy for managing severe intraoperative complications, allowing patient stabilization before definitive tumor removal.</ns3:p>