Pure Endoscopic Supracerebellar Infratentorial Approach to the Pineal Region: A Case Series

Shahrestani, Shane; Ravi, Vignesh; Strickland, Benjamin A.; Rutkowski, Martin J.; Zada, Gabriel

doi:10.1016/j.wneu.2020.02.074

Cited by 15 publications

(10 citation statements)

References 15 publications

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“…5,20 In our opinion, surgical resection is necessary for the treatment of most pineal region lesions in children, although it could lead to some negative effects, as shown in Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/F651. Some researchers [21][22][23] believe that total resection and endoscopicassisted surgery is beneficial to patients because such approaches are associated with fewer complications and better outcomes, as we demonstrated in the current study (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/SCS/ F651). Moreover, some surgeons are of the opinion that larger lesion size is a contraindication to resection (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/ FIGURE 1.…”

Section: Necessity Of Surgical Resection For Children With Pineal Reg...supporting

confidence: 65%

Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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Background: Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial. Methods: A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed. Results: Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome. Conclusions: For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.

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Section: Necessity Of Surgical Resection For Children With Pineal Reg...supporting

confidence: 65%

Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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“… 1 The endoscope assistance is helpful for increasing visibility, illumination, and maneuverability of instruments in a tight surgical corridor, and it can even be used as the sole option for tumors in the pineal region. 4 The upward displacement of venous structures favors the use of the supracerebellar infratentorial approach; however, larger tumors with supratentorial extension may require other strategies, such as the combined use of a transtentorial approach, as was done in the present case.…”

Section: Transcriptmentioning

confidence: 71%

Microscopic resection of a giant epidermoid tumor of the pineal region via supracerebellar infra and transtentorial approach with endoscope assistance

Zanini

Alves

Botta

et al. 2021

Neurosurgical Focus: Video

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The authors present a case of a 22-year-old male who developed hydrocephalus symptoms related to a giant epidermoid tumor at the pineal region. The surgical approach and technique for a large epidermoid tumor in this area are extensively discussed. A paramedian contralateral supracerebellar infratentorial and transtentorial approach was performed, with the patient in a semisitting position. The tumor was removed using a microscopic technique, and endoscope assistance was used in order to reach the areas unable to be visualized under the microscope. The patient was neurologically intact at his 2-year follow-up, and postoperative MRI showed a significant decrease in the tumoral volume. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2128.

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“…Supracerebellar infratentorial approach, performed by microsurgery or endoscopic techniques, is a feasible alternative in cases of pineal tumours. The endoscopic approach offers a better visualization of the tumour, a wider range of motion of surgical instruments, a shorter duration of the procedure, a quick recovery, and fewer complications [ 116 , 117 ]. Second-look surgery should be considered in patients with residual tumour or high serum/CSF markers after an appropriate treatment protocol.…”

Section: Current Managementmentioning

confidence: 99%

Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma

Ilcus

Silaghi

Georgescu

et al. 2021

JPM

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Intracranial germinomas are rare tumours, usually affecting male paediatric patients. They frequently develop in the pineal and suprasellar regions, causing endocrinological disturbances, visual deficits, and increased intracranial pressure. The diagnosis is established on magnetic resonance imaging (MRI), serum and cerebrospinal fluid (CSF) markers, and tumour stereotactic biopsy. Imaging techniques, such as susceptibility-weighted imaging (SWI), T2* (T2-star) gradient echo (GRE) or arterial spin labelling based perfusion-weighted MRI (ASL-PWI) facilitate the diagnosis. Germinomas are highly radiosensitive tumours, with survival rates >90% in the context of chemoradiotherapy. However, patients with resistant disease have limited therapeutic options and poor survival. The aim of this review is to highlight the genetic, epigenetic, and immunologic features, which could provide the basis for targeted therapy. Intracranial germinomas present genetic and epigenetic alterations (chromosomal aberrations, KIT, MAPK and PI3K pathways mutations, DNA hypomethylation, miRNA dysregulation) that may represent targets for therapy. Tyrosine kinase and mTOR inhibitors warrant further investigation in these cases. Immune markers, PD-1 (programmed cell death protein 1) and PD-L1 (programmed death-ligand 1), are expressed in germinomas, representing potential targets for immune checkpoint inhibitors. Resistant cases should benefit from a personalized management: genetic and immunological testing and enrolment in trials evaluating targeted therapies in intracranial germinomas.

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Pure Endoscopic Supracerebellar Infratentorial Approach to the Pineal Region: A Case Series

Cited by 15 publications

References 15 publications

Treatment of Pineal Region Lesions in Children

Treatment of Pineal Region Lesions in Children

Microscopic resection of a giant epidermoid tumor of the pineal region via supracerebellar infra and transtentorial approach with endoscope assistance

Molecular Pathology and Targeted Therapies for Personalized Management of Central Nervous System Germinoma

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