An overview of the current surgical options for pineal region tumors

Abstract

Background:The list of pineal region tumors comprises an extensive array of pathological entities originating within one of the most complex areas of the intracranial cavity. With the exception of germ cell tumors, microsurgical excision is still nowadays the mainstay of management for most pineal region tumors.Methods:A search of the medical literature was conducted for publications addressing surgical options for management of pineal region tumors.Results:The infratentorial supracerebellar and the occipital transtentorial approaches are currently the most frequently used approaches for pineal region tumors. Endoscopic tumor biopsy with simultaneous endoscopic third ventriculostomy has emerged as a minimally invasive and highly effective strategy for initial management since it addresses the issue of tissue diagnosis and offers a solution for the associated hydrocephalus frequently encountered in these patients. Endoscope-assisted microsurgery and purely endoscopic excision have been reported in few reports and are likely to be more utilized in the future.ConclusionPreoperative planning is very crucial and should most importantly be individualized according to the anatomical features of the lesion and structures encountered during the procedure.

Twenty-seven cases of pineal parenchymal tumours of intermediate differentiation: mitotic count, Ki-67 labelling index and extent of resection predict prognosis

“…The approach was determined by the location of the tumour and its demographic relationship with the surrounding structures. Besides the three approaches mentioned above (Material and Methods section), the infratentorial-supracerebellar approach has been reported to allow efficient exposure and safe removal of pineal region tumours 23 24 32 34 35. However, in our series, most tumours are of a large size with superior or lateral extensions into third or lateral ventricles (figures 1 and 2).…”

“…Management of hydrocephalus was successful with this strategy. Considering the heterogeneity of PPTID compared to other pineal region tumours, an open procedure was reported to be optimal to obtain sufficient amount of tumour for accurate diagnosis and for distinguishing PPTID from PC and PB 14 32. In our study, open resection was conducted in all the patients to confirm a sound histopathological diagnosis, which made a solid basis for further analysis.…”

“…Moreover, the tumours often have a significant portion located above the deep venous system, which displaced the deep draining veins downwards towards the cerebellum. Tumours with this location are difficult to resect through an intratentorial-supracerebellar approach due to the interposition of the Gallen venous system 22 32 35. In addition, surgical corridor to the lateral portion of the tumour would be obstructed by the tentorium 35–38.…”

Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space

“…[1,2,9,12,16,21,24] The choice of surgical approach depends primarily on the size and location of the tumor as well as angiographic characteristics.…”

Recent advances in molecular biology and treatment strategies for intracranial germ cell tumors

“…The ability to obtain a large amount of tissue and perform more extensive tissue sampling by open resection is a clear advantage over endoscopic biopsy. [76] There are at least 4 reasons for surgery. 1) More samples obtained during surgery provide more accurate and comprehensive understanding of histology of IGCTs.…”