Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database Analysis

Abstract

Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches. Design Retrospective database review. Setting Multi-institutional database. Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach. Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies. Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological. Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.

Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial

“…Most surgical series of resection of pineal tumors of various histologies with sufficient detail on postoperative follow-up report on the experience of single institutions, often even single surgeons [ 64 ]. Postoperative morbidity of resective procedures in recent monoinstitutional series ranges between 19% and 22% [ 33 , 35 , 41 , 49 , 62 , 63 , 65 , 66 , 67 ], with up to 45.6% adverse events in the period of 30 days after surgery [ 68 ].…”

Thirty-day morbidity and mortality following primary total elbow arthroplasty in octogenarians

“…complications for patients undergoing surgical procedures. 13,14 Previous studies have shown a low disagreement rate when this database was audited. 15 NSQIP has been used in the surgical field to track the preoperative data and postoperative outcomes of individual patients.…”