Transcortical Approach to a Huge Pineal Mature Teratoma

Berhouma, Moncef; Jemel, Hafedh; Ksira, I.; Khaldi, Mohamed

doi:10.1159/000110663

Cited by 9 publications

(3 citation statements)

References 11 publications

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“…[81][82][83][84] Finally, a trans-ventricular approach is recommended when the tumor extends anteriorly into the third ventricle. [81][82][83][84] These procedures carry risk of postoperative complications, including cerebellar injury (infra-tentorial supra-cerebellar), memory disturbances (transventricular), and visual field dysfunction (suboccipital trans-tentorial and trans-cortical trans-parietal). 57,[81][82][83][84]…”

Section: Surgical Resectionmentioning

confidence: 99%

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Diagnosis and Management of Pineal Germinoma: From Eye to Brain

Cohen¹,

Litofsky²

2023

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Pineal germinomas can be very complex in terms of presentation, diagnosis, and management. This review attempts to simplify this complexity in an organized manner, addressing the anatomic relationships that provide the basis for the uniqueness of pineal germinoma. Ocular findings and signs and symptoms of elevated intracranial pressure are the keys to suspecting the diagnosis and obtaining the necessary imaging and cerebrospinal fluid studies. Other symptoms can suggest spread beyond the pineal region. Surgery may only be needed to obtain tissue for a definitive diagnosis, as germinoma is highly responsive to chemotherapy and focused radiation therapy. Hydrocephalus, usually related to tumor obstruction of the cerebral aqueduct, may also need to be addressed. Outcome for pineal germinoma is usually excellent, but relapse can occur and may require additional intervention. These issues are detailed in this review.

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Section: Surgical Resectionmentioning

confidence: 99%

“…[81][82][83][84] These procedures carry risk of postoperative complications, including cerebellar injury (infra-tentorial supra-cerebellar), memory disturbances (transventricular), and visual field dysfunction (suboccipital trans-tentorial and trans-cortical trans-parietal). 57,[81][82][83][84]…”

Section: Surgical Resectionmentioning

confidence: 99%

Diagnosis and Management of Pineal Germinoma: From Eye to Brain

Cohen¹,

Litofsky²

2023

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“…Other approaches are possible, depending on the tumor’s extension laterally or in the third ventricle [ 65 , 66 , 67 , 68 ]. A significant lateral extension may be managed by a transcortical transparietal approach with a high risk of visual field complications.…”

Section: The Role Of Surgerymentioning

confidence: 99%

Diagnosis and Treatment of Pineal Region Tumors in Adults: A EURACAN Overview

Lombardi

Poliani

Manara

et al. 2022

Cancers

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Pineal region tumors are rare intracranial tumors, accounting for less than 1% of all adult intracranial tumor lesions. These lesions represent a histologically heterogeneous group of tumors. Among these tumors, pineal parenchymal tumors and germ cell tumors (GCT) represent the most frequent types of lesions. According to the new WHO 2021 classification, pineal parenchymal tumors include five distinct histotypes: pineocytoma (PC), pineal parenchymal tumors of intermediate differentiation (PPTID), papillary tumor of the pineal region (PTPR), pinealoblastoma (PB), and desmoplastic myxoid tumor of the pineal region, SMARCB1-mutant; GCTs include germinoma, embryonal carcinoma, yolk sac tumor, choriocarcinoma, teratoma, mixed GCTs. Neuroradiological assessment has a pivotal role in the diagnostic work-up, surgical planning, and follow-up of patients with pineal masses. Surgery can represent the mainstay of treatment, ranging from biopsy to gross total resection, yet pineal region tumors associated with obstructive hydrocephalus may be surgically managed via ventricular internal shunt or endoscopic third ventriculostomy. Radiotherapy remains an essential component of the multidisciplinary treatment approach for most pineal region tumors; however, treatment volumes depend on the histological subtypes, grading, extent of disease, and the combination with chemotherapy. For localized germinoma, the current standard of care is chemotherapy followed by reduced-dose whole ventricular irradiation plus a boost to the primary tumor. For pinealoblastoma patients, postoperative radiation has been associated with higher overall survival. For the other pineal tumors, the role of radiotherapy remains poorly studied and it is usually reserved for aggressive (grade 3) or recurrent tumors. The use of systemic treatments mainly depends on histology and prognostic factors such as residual disease and metastases. For pinealoblastoma patients, chemotherapy protocols are based on various alkylating or platinum-based agents, vincristine, etoposide, cyclophosphamide and are used in association with radiotherapy. About GCTs, their chemosensitivity is well known and is based on cisplatin or carboplatin and may include etoposide, cyclophosphamide, or ifosfamide prior to irradiation. Similar regimens containing platinum derivatives are also used for non-germinomatous GCTs with very encouraging results. However, due to a greater understanding of the biology of the disease’s various molecular subtypes, new agents based on targeted therapy are expected in the future. On behalf of the EURACAN domain 10 group, we reviewed the most important and recent developments in histopathological characteristics, neuro-radiological assessments, and treatments for pineal region tumors.

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