Treatment results for pineal region tumors: role of stereotactic biopsy plus adjuvant therapy vs. open resection

Abstract

Because optimal therapeutic strategies vary with tumor type, a histologic diagnosis by either stereotactic or endoscopic biopsy or open surgery is the foundation of management decisions. Stereotactic biopsy has the advantage of ease and minimal invasiveness but is associated with more sampling errors than open surgery (19), while open resection facilitates maximal removal of tumor volume with more diagnostic accuracy. However, all surgical procedures in the pineal region, including both stereotactic biopsy and open surgery, are potentially hazardous (3,11). █ INTRODUCTIONPineal region tumors represent 0.4-1.0% of intracranial tumors and can harbor highly diverse histologic tumor subtypes, including germ cell, pineal parenchymal, and glial tumors (21).The tumor manifestations are the consequence of their pressure effects and consist of visual disturbances, headache, mental deterioration, Parinaud's syndrome, non-communicating hydrocephalus, and sometimes dementia-like behavior. MATERIAL and METHODS:We present the results of 48 patients with pineal tumor treated either by stereotactic biopsy followed by adjuvant therapy (23 patients) or open surgical resection without (18 patients) or with (7 patients) adjuvant therapy in Shohada Tajrish Hospital, Iran (1993.RESULTS: unremarkable pathology yield was 3/23 in the biopsy and 1/25 in the surgical group. Perioperative mortality and morbidity were 4.3% and 0% in the biopsy group and 32.0% and 4.0% in the surgical group. Analysis showed that age, gender, cranial nerve deficit, motor deficit, preoperative Karnofsky Performance Score (KPS), midbrain involvement, and brain stem involvement had no effect on neither perioperative mortality nor long-term survival, while local invasion and pineocytoma pathology increased perioperative mortality and presence of hydrocephalus and pineoblastoma pathology significantly decreased long-term survival. Hospitalization length was shorter in the stereotactic biopsy plus adjuvant therapy group. CONCLUSION:The results of the study suggests that although gross total resection is the standard of care in most pineal tumors nowadays, stereotactic biopsy followed by adjuvant therapy may still be a safe and viable option.

Treatment outcomes for pediatric pineoblastoma: a single institute experience in Taiwan

“…One recent paper from Iran reported a 22 years old patient with pineoblastoma and received biopsy and Gamma Knife radiosurgery over the cranial area with 14 Gy. The treatments have shown excellent tumor control without progression after 45 months of followup until the study ended (6). A case report in the Journal of Neurosurgery reported an unusually long survival of a pineoblastoma patient with a 9-year follow-up period after stereotaxic biopsy, a shunting procedure, and radiotherapy (16).…”

“…Treatment outcomes for pediatric pineoblastoma: a single institute experience in Taiwan of central nervous system (CNS) tumor 2007 and 2016 recognizes four major subgroups of pineal-parenchymal tumors: pineocytoma (WHO grade I), pineal-parenchymal tumors of intermediate differentiation (WHO grades II and III), and pineoblastoma (WHO grade IV). Tumor manifestations are the consequence of compression of the brain stem and consist of nausea/vomiting, visual disturbances, headache, mental deterioration, and cranial nerve deficits such as loss of up-ward gaze (Parinaud syndrome) (6). Generally, pineoblastomas are treated in a similar manner to high-risk medulloblastomas.…”

Keyhole surgery of pineal area tumors - personal experience in 22 patients

“…In adults, these tumors are rare. Most pineal tumors originate from the pineal gland – pineocytoma and pineoblastoma [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 24 ], some other tumors in this area are PNET, glial tumors, metastatic lesions, meningiomas, papillary tumors [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Other lesions such as central neurinoma [ 17 , 18 ] and cavernous angioma [ 13 ] are extremely rare.…”

“…The extensive variety of possible histological subtypes makes it imperative to establish a tissue diagnosis in patients with pineal region tumor. Management decisions regarding adjuvant therapy, prognosis, and follow-up strategies vary based on the histological diagnosis [ 2 , 4 , 5 , 24 ]. The patients were healthy after total removal of the benign tumors in our study.…”

“…Tumors of the pineal area are uncommon and they consist of 0.5-1% of all intracranial tumors [ 1 , 2 ]. These lesions are challenging to access due to the deep surgical field and the surrounding associated critical neurovascular structures.…”