Stereotactic Biopsy of Pineal Lesions

Quick-Weller, Johanna; Lescher, Stephanie; Baumgarten, Peter; Dinc, Nazife; Bruder, Markus; Weise, Lutz; Seifert, Volker; Marquardt, Gerhard

doi:10.1016/j.wneu.2016.04.130

Cited by 18 publications

(12 citation statements)

References 16 publications

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“…Even after a median observation of 4 years and 1 month, only 60.1% (17 of 28) of our patient cohort needed surgical resection. This is in line with reported rates of necessary surgical resection after primary endoscopic or stereotactic biopsy with 21–60% [ 2 , 14 , 23 , 31 , 33 ]. Based on the data of this presented pediatric series and on the reviewed publications, primary resection, without preceding biopsy, cannot be recommended in children.…”

Section: Discussionsupporting

confidence: 90%

“…However, a stereotactic biopsy does not resolve any coexisting hydrocephalus, thus requiring additionally either an EVD, insertion of a VP shunt, or an ETV in a second surgical intervention [ 18 , 31 ]. The success rates of stereotactic biopsy are reported to be high with a diagnostic yield of 93.7 to 100% [ 3 , 18 , 31 ].…”

Section: Discussionsupporting

confidence: 80%

“…The confirmation of a histological diagnosis can also be obtained by an endoscopic procedure, while stereotactic biopsy represents the possible alternative. However, a stereotactic biopsy does not resolve any coexisting hydrocephalus, thus requiring additionally either an EVD, insertion of a VP shunt, or an ETV in a second surgical intervention [ 18 , 31 ]. The success rates of stereotactic biopsy are reported to be high with a diagnostic yield of 93.7 to 100% [ 3 , 18 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

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Management of pineal region tumors in a pediatric case series

et al. 2020

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Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendoscopic biopsy and endoscopic third ventriculocisternostomy (ETV) in patients with pineal region tumors between 2006 and 2019 in a single-center retrospective crosssectional study with regard to diagnostic yield, hydrocephalus treatment, as well as impact on further antitumoral management. Out of 28 identified patients, 23 patients presented with untreated hydrocephalus and 25 without histological diagnosis. One patient underwent open biopsy, and 24 received a neuroendoscopic biopsy with concomitant hydrocephalus treatment if necessary. Eighteen primary ETVs, 2 secondary ETVs, and 2 ventriculoperitoneal shunts (VPSs) were performed. Endoscopic biopsy had a diagnostic yield of 95.8% (23/24) and complication rates of 12.5% (transient) and 4.2% (permanent), respectively. ETV for hydrocephalus management was successful in 89.5% (17/19) with a median follow-up of more than 3 years. Following histological diagnosis, 8 patients (28.6%) underwent primary resection of their tumor. Another 9 patients underwent later-stage resection after either adjuvant treatment (n = 5) or for progressive disease during observation (n = 4). Eventually, 20 patients received adjuvant treatment and 7 were observed after primary management. One patient was lost to follow-up. Heterogeneity of pineal region tumor requires histological confirmation. Primary biopsy of pineal lesions should precede surgical resection since less than a third of patients needed primary surgical resection according to the German pediatric brain tumor protocols. Interdisciplinary decision making upfront any treatment is warranted in order to adequately guide treatment.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

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Management of pineal region tumors in a pediatric case series

et al. 2020

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“…The immunophenotype would not have been classic for melanoma, lung, prostate, kidney, bladder or lower gastrointestinal origin. Moreover, signet ring features are classically associated with signet ring cell carcinoma originating from the stomach, which further raised suspicion of a gastrointestinal origin of the pineal lesion (12).…”

Section: Discussionmentioning

confidence: 99%

Pineal Gland Metastasis From Poorly Differentiated Carcinoma of Unknown Primary Origin

et al. 2020

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Pineal metastasis is an exceedingly rare finding in patients with systemic malignancies. Such lesions are typically the manifestation of a primary lung cancer; nonetheless, a variety of malignancies have been reported to disseminate to the pineal gland including gastrointestinal, endocrine, and skin cancers, among others. However, to our knowledge, pineal gland metastasis without a primary origin has yet to be described. Carcinoma of unknown primary origin is a heterogeneous group of cancers characterized by the presence of metastatic disease without an identifiable primary tumor on metastatic workup. Here, we present a case of a 65-year-old male found to have a heterogeneously enhancing lesion of the pineal gland as well as an enhancing lesion of the left cerebellar hemisphere. Comprehensive metastatic workup demonstrated multifocal metastatic adenopathy without an identifiable primary lesion. Stereotactic biopsy of the pineal lesion revealed poorly differentiated carcinoma with an immunophenotype most consistent with gastrointestinal origin. To our knowledge, this is the first case to describe a pineal gland metastasis without a primary origin. We discuss the relevant literature on pineal gland metastases as well as carcinoma of unknown primary origin.

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“…The latter can be treated with radiotherapy and chemotherapy after a clear diagnosis by tumor biopsy. Stereotactic biopsy of the pineal tumor has been conducted in some cases, but it usually causes complications, such as postoperative bleeding [12].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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Background: The pineal region tumors are surrounded by important structures. Neuroendoscopy has been increasingly used at home and abroad. This study is to simulate pure neuroendoscopic infratentorial supracerebellar approach for resection of pineal region tumor from the cadaveric head, and discuss the advantages and safety through this corridor. Methods: The anatomical structure for resection of pineal region tumor was visualized through pure neuroendoscopic infratentorial supracerebellar approach in three cadaveric heads. Three cases with pineal region tumors were retrospectively analyzed and summarized between June 2017 and December 2017. All cases were operated through pure neuroendoscopic infratentorial supracerebellar approach in the first affiliated hospital of Fujian medical university. Results: The anatomical structures of pineal region can be completely visualized by pure neuroendoscopic infratentorial supracerebellar corridor in the cadaveric head. Among the three cases, the first case was total resection, the second case was subtotal resection and the last case was partial resection. The postoperative pathology revealed cavernous hemangioma, germinoma and yolk sac tumor, respectively. The patients were followed-up for 1-6 months and had normal life.The KPS (karnofsky performance status) score was 100. Conclusion: The anatomical structure of the pineal region can be completely visualized and the tumor can be safely removed through pure neuroendoscopic infratentorial supracerebellar approach.

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Stereotactic Biopsy of Pineal Lesions

Cited by 18 publications

References 16 publications

Management of pineal region tumors in a pediatric case series

Management of pineal region tumors in a pediatric case series

Pineal Gland Metastasis From Poorly Differentiated Carcinoma of Unknown Primary Origin

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

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