Pineal tumors in children and adolescents

Abstract

Tumors of the pineal region account for 3% to 8% of pediatric intracranial tumors. The treatment of such tumors has been in a state of flux between conservative therapy (cerebrospinal fluid shunting and radiotherapy) and direct surgical removal. A brief history and review of the literature with analysis of both approaches is given, and the Mayo Clinic's experience with conservative treatment of tumors in the pineal region in patients 20 years old and younger (27 cases) is studied and analyzed. The series comprises 21 boys and six girls, with an age range of 1 to 20 years (mean 13.7 years). Follow-up examinations are complete and range from 1 to 24 years, with a mean follow-up period of 7.8 years. The median survival time for these patients treated with shunt and radiotherapy is 17.7 years. There was no mortality from treatment and complications were rare. The details of the clinical presentation, diagnostic findings, pathology, therapy, recurrence, and survival are presented. All patients under 6 years of age (six cases) had recurrences, 50% in other areas in the brain and 50% in the spinal cord, perhaps pointing to the need for whole-brain and spinal-axis irradiation in patients in this age group. The results of this study of the conservative approach form a standard against which results of any other type of therapy may be compared.

Anatomy and surgery of pure neuroendoscopic infratentorial supracerebellar approach for resection of pineal region tumor

“…Tumors of the pineal region account for 3-8% of all central nervous system tumors [10]. The pathological types include germinoma, nongerminomatous germ cell tumors (teratoma, embryonal carcinoma, choriocarcinoma), pineal parenchymal tumors (pineocytoma and pineoblastoma), glial tumor (ependymoma) and other tumors (cavernous hemangioma and meningiomas).…”

Germ cell tumours of the central nervous system in children—controversies in radiotherapy

“…Total doses less than 45 Gy have been associated with inferior control rates of 50-60% as opposed to 80-90% in those patients receiving 50 Gy [10,11,21,36,37,52]. More recent reports favour a total dose of 45 Gy [40,42,48,53].…”

“…Pineal tumours occur more frequently in boys and suprasellar tumours in girls although some report an equal prevalence of suprasellar tumours in both sexes [1,2]. GCT tumours spread locally along leptomeninges, directly along the floor of the 4th ventricle to involve the floors and walls leading to endocrinological disorders, along the CSF to involve the spinal cord and rarely systemically [5,6,[8][9][10].…”

“…These tumours account for 3-8% of brain tumours in children in the Western world, the incidence ranging from 1% of all intracranial neoplasms in the United States and Western Europe, to 3% in Japan, and up to 12.5% in Far East Asia [1,[5][6][7]. GCT more commonly arise in the pineal gland (51%) and suprasellar region (30%), and very rarely in sites such as the basal ganglia (3%), cerebellum (1%), and in other locations (16%) [1,6,9,10]. CNS GCT usually develop in the first three decades, the median age at diagnosis being around 12 years [6].…”

Review of Radiosurgery of Pineal Parenchymal Tumors. Long Survival Following 125-Iodine Brachytherapy of Pineoblastomas in 2 Cases

“…Symptoms caused by PRTs can be a result of increased intracranial pressure provoked by obstructive hydrocephalus, pressure on the tectum mesencephali and more rarely, pressure on the hypothalamus. Hormonal changes can be caused by the hormonal activity of the tumor, or by the damage to the surrounding tissues [2,9,10].…”