A patient with adenocarcinoma of the kidney metastatic lo the quadrigeminal plate of the midbrain presented with acute obstructive hydrocephalus and early tonsillar herniation. Because the majority of these carcinomas are resistant to radiation therapy, only limited treatment choices were available. Initially, a ventriculoperitoneal shunt relieved the hydrocephalus and neurologic symptoms. After a short course of improvement, with decompressed ventricles demonstrated by postoperative computed tomography, the patient developed additional neurologic signs, leading to the decision to excise the metastatic tumor. Convalescence was complicated but the patient survived for six months, succumbing to respiratory failure presumably caused by lung metastases
