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Journal of Neuro-Oncology
Published in: Journal of Neuro-Oncology 2/2016

01-11-2016 | Topic Review

Microsurgical resection of pineal region tumors

Authors: Adam M. Sonabend, Stephen Bowden, Jeffrey N. Bruce

Published in: Journal of Neuro-Oncology | Issue 2/2016

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Abstract

The extensive variety of possible histologic subtypes makes it imperative to establish a tissue diagnosis in patients with pineal region tumors. Management decisions regarding adjuvant therapy, prognosis, and follow-up strategies vary with the histologic diagnosis. Specialized surgical and stereotactic techniques have evolved to provide the neurosurgeon with an array of safe and effective options for obtaining a tissue diagnosis. Advanced microsurgical techniques combined with improved preoperative management and postoperative critical care methods have made aggressive surgical resection a mainstay of management. Aggressive surgical resection has resulted in excellent long-term prognoses for nearly all patients with benign tumors and a large percentage of patients with malignant tumors. However, pineal region surgery remains fraught with potential pitfalls, and these favorable results are dependent on an advanced level of surgical expertise.
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Literature
1.
Bruce J (1993) Management of pineal region tumors. Neurosurg Quart 3(2):103–119
2.
Sano K (1983) Pineal region tumors: problems in pathology and treatment. Clin Neurosurg 30:59–91PubMed
3.
4.
Konovalov AN, Pitskhelauri DI (2003) Principles of treatment of the pineal region tumors. Surg Neurol 59(4):250–268PubMedCrossRef
5.
Fukui M, Matsuoka S, Hasuo K, Numaguchi Y, Kitamura K (1983) Cavernous hemangioma in the pineal region. Surg Neurol 20:209–215PubMedCrossRef
6.
Fetell MR, Bruce JN, Burke AM, Cross DT, Torres RA, Powers JM, Stein BM (1991) Non-neoplastic pineal cysts. Neurology 41:1034–1040PubMedCrossRef
7.
8.
9.
Cummins FM, Taveras JM, Schlesinger EB (1960) Treatment of gliomas of the third ventricle and pinealomas; with special reference to the value of radiotherapy. Neurology 10:1031–1036PubMedCrossRef
10.
Donat JF, Okazaki H, Gomez MR, Reagan TJ, Baker HL Jr, Laws ER Jr (1978) Pineal tumors. A 53-year experience. Arch Neurol 35:736–740PubMedCrossRef
11.
12.
Wagenen V (1931) A surgical approach for the removal of certain pineal tumors. Surg Gynecol Obstet 37:216–220
13.
Dandy W (1936) Operative experience in cases of pineal tumor. Arch Surg 33:19–46CrossRef
14.
Duffner PK, Cohen ME, Thomas PR, Lansky SB (1985) The long-term effects of cranial irradiation on the central nervous system. Cancer 56:1841–1846PubMedCrossRef
15.
Jenkin D, Berry M, Chan H, Greenberg M, Hendrick B, Hoffman H, Humphreys R, Sonley M, Weitzman S (1990) Pineal region germinomas in childhood treatment considerations. Int J Radiat Oncol Biol Phys 18:541–545PubMedCrossRef
16.
Sakai N, Yamada H, Andoh T, Hirata T, Shimizu K, Shinoda J (1988) Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors. Acta Oncol 27:43–50PubMedCrossRef
17.
Casentini L, Colombo F, Pozza F, Benedetti A (1990) Combined radiosurgery and external radiotherapy of intracranial germinomas. Surg Neurol 34:79–86PubMedCrossRef
18.
Chapman PH, Linggood RM (1980) The management of pineal area tumors: a recent reappraisal. Cancer 46:1253–1257PubMedCrossRef
19.
Dempsey PK, Kondziolka D, Lunsford LD (1992) Stereotactic diagnosis and treatment of pineal region tumours and vascular malformations. Acta Neurochir (Wien) 116:14–22CrossRef
20.
Edwards MS, Hudgins RJ, Wilson CB, Levin VA, Wara WM (1988) Pineal region tumors in children. J Neurosurg 68:689–697PubMedCrossRef
21.
Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphreys RP (1994) Pineal region tumors in childhood. Experience at the Hospital for Sick Children, 1983. Pediatr Neurosurg 21:91–103 (discussion 104) PubMedCrossRef
22.
Neuwelt EA (1985) An update on the surgical treatment of malignant pineal region tumors. Clin Neurosurg 32:397–428PubMed
23.
Pluchino F, Broggi G, Fornari M, Franzini A, Solero CL, Allegranza A (1989) Surgical approach to pineal tumours. Acta Neurochir (Wien) 96:26–31CrossRef
24.
Rout D, Sharma A, Radhakrishnan VV, Rao VR (1984) Exploration of the pineal region: observations and results. Surg Neurol 21:135–140PubMedCrossRef
25.
26.
27.
Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphreys RP (1984) Experience with pineal region tumours in childhood. Neurol Res 6:107–112PubMedCrossRef
28.
Zulch KJ (1981) Reflections on the surgery of the pineal gland (a glimpse into the past). Gleanings from medical history. Neurosurg Rev 4:159–163PubMedCrossRef
29.
30.
Oppenheim H, Krause F (1913) Operative Erfolge bei Geschwulsten der sehhugel- und. Vierhugelgegend. Berl Klin Wochenshr 50:2316–2322
31.
Dandy W (1921) An operation for the removal of pineal tumors. Surg Gynecol Obstet 33:113–119
32.
Krause F (1926) Operative Frielegung der Vierhugel nebst Beobachtungen uber Hirndruck und Dekompression. Zentrabl Chir 53:2812–2819
33.
Bruce J, Fetell M, Stein B (1996) Surgical approaches to pineal tumors. In: Wilkins RH, Rengachary SS (eds) Neurosurgery. McGraw-Hill, New York
34.
Lapras C, Patet JD, Mottolese C, Lapras C Jr (1987) Direct surgery for pineal tumors: occipital-transtentorial approach. Prog Exp Tumor Res 30:268–280PubMedCrossRef
35.
36.
Sano K (1987) Pineal region and posterior third ventricular tumors: a surgical overview. Williams & Wilkins, Baltimore
37.
Little KM, Friedman AH, Fukushima T (2001) Surgical approaches to pineal region tumors. J Neurooncol 54:287–299PubMedCrossRef
38.
Reid WS, Clark WK (1978) Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3:1–8PubMedCrossRef
39.
Bruce J (2011) Youman’s neurological surgery: pineal tumors. WB Saunders, Philadelphia
40.
Hernesniemi J, Romani R, Albayrak BS, Lehto H, Dashti R, Ramsey C 3rd, Karatas A, Cardia A, Navratil O, Piippo A, Fujiki M, Toninelli S, Niemela M (2008) Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 70:576–583. doi:10.​1016/​j.​surneu.​2008.​07.​019 PubMedCrossRef
41.
Qi S, Fan J, Zhang XA, Zhang H, Qiu B, Fang L (2014) Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir (Wien) 156:2253–2262. doi:10.​1007/​s00701-014-2224-4 CrossRef
42.
43.
Goodman RR (1993) Magnetic resonance imaging-directed stereotactic endoscopic third ventriculostomy. Neurosurgery 32:1043–1047 (discussion 1047) PubMedCrossRef
44.
Bruce JN, Ogden AT (2004) Surgical strategies for treating patients with pineal region tumors. J Neurooncol 69:221–236PubMedCrossRef
45.
Connolly ES, Bruce J, Sonabend AM (2011) Pineal cell and germ cell tumors. In: Kaye AH, Laws ER (eds) Brain tumors, 3rd edn. Elsevier, New York
46.
47.
Allen JC, Nisselbaum J, Epstein F, Rosen G, Schwartz MK (1979) Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg 51:368–374. doi:10.​3171/​jns.​1979.​51.​3.​0368 PubMedCrossRef
48.
49.
Arita N, Ushio Y, Hayakawa T, Uozumi T, Watanabe M, Mori T, Mogami H (1980) Serum levels of alpha-fetoprotein, human chorionic gonadotropin and carcinoembryonic antigen in patients with primary intracranial germ cell tumors. Oncodev Biol Med 1:235–240PubMed
50.
Bamberg M, Metz K, Alberti W, Heckemann R, Schulz U (1984) Endodermal sinus tumor of the pineal region. Metastases through a ventriculoperitoneal shunt. Cancer 54:903–906PubMedCrossRef
51.
52.
Wilson ER, Takei Y, Bikoff WT, O’Brien MS, Tindall GT, Boehm WM (1979) Abdominal metastases of primary intracranial yolk sac tumors through ventriculoperitoneal shunts: report of three cases. Neurosurgery 5:356–364PubMedCrossRef
53.
Haase J, Borgaard-Pedersen B (1979) Alpha-feto-protein (AFP) and human chorionic gonadotropin (HCG) as biochemical markers of intracranial germ-cell tumours. Acta Neurochir (Wien) 50:67–69CrossRef
54.
55.
56.
57.
Russell DS, Rubinstein LJ (1989) Tumours and tumour-like lesions of maldevelopmental origin. In: Russell DS, Rubinstein LJ (eds) Pathology of tumours of the nervous system. Williams & Wilkins, Baltimore, p 664
58.
59.
60.
61.
Stein BM, Bruce JN (1992) Surgical management of pineal region tumors (honored guest lecture). Clin Neurosurg 39:509–532PubMed
62.
Fevre-Montange M, Hasselblatt M, Figarella-Branger D, Chauveinc L, Champier J, Saint-Pierre G, Taillandier L, Coulon A, Paulus W, Fauchon F, Jouvet A (2006) Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol 65:1004–1011. doi:10.​1097/​01.​jnen.​0000240462.​80263.​13 PubMedCrossRef
63.
Calaminus G, Bamberg M, Jurgens H, Kortmann RD, Sorensen N, Wiestler OD, Gobel U (2004) Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr 216:141–149. doi:10.​1055/​s-2004-822626 PubMedCrossRef
64.
Satoh H, Uozumi T, Kiya K, Kurisu K, Arita K, Sumida M, Ikawa F (1995) MRI of pineal region tumours: relationship between tumours and adjacent structures. Neuroradiology 37:624–630PubMedCrossRef
65.
Zee CS, Segall H, Apuzzo M, Destian S, Colletti P, Ahmadi J, Clark C (1991) MR imaging of pineal region neoplasms. J Comput Assist Tomogr 15:56–63PubMedCrossRef
66.
Fujimaki T, Matsutani M, Funada N, Kirino T, Takakura K, Nakamura O, Tamura A, Sano K (1994) CT and MRI features of intracranial germ cell tumors. J Neurooncol 19:217–226PubMedCrossRef
67.
68.
D’Andrea AD, Packer RJ, Rorke LB, Bilaniuk LT, Sutton LN, Bruce DA, Schut L (1987) Pineocytomas of childhood. A reappraisal of natural history and response to therapy. Cancer 59:1353–1357PubMedCrossRef
69.
Kersh CR, Constable WC, Eisert DR, Spaulding CA, Hahn SS, Jenrette JM 3rd, Marks RD Jr (1988) Primary central nervous system germ cell tumors. Effect of histologic confirmation on radiotherapy. Cancer 61:2148–2152PubMedCrossRef
70.
Choi JU, Kim DS, Chung SS, Kim TS (1998) Treatment of germ cell tumors in the pineal region. Childs Nerv Syst 14:41–48PubMedCrossRef
71.
Bruce JN, Stein BM (1995) Surgical management of pineal region tumors. Acta Neurochir (Wien) 134:130–135CrossRef
72.
73.
Schild SE, Scheithauer BW, Haddock MG, Wong WW, Lyons MK, Marks LB, Norman MG, Burger PC (1996) Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer 78:2564–2571PubMedCrossRef
74.
Kreth FW, Schatz CR, Pagenstecher A, Faist M, Volk B, Ostertag CB (1996) Stereotactic management of lesions of the pineal region. Neurosurgery 39:280–289 (discussion 289–291) PubMedCrossRef
75.
Pecker J, Scarabin JM, Vallee B, Brucher JM (1979) Treatment in tumours of the pineal region: value of sterotaxic biopsy. Surg Neurol 12:341–348PubMed
76.
Regis J, Bouillot P, Rouby-Volot F, Figarella-Branger D, Dufour H, Peragut JC (1996) Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 39:907–912 (discussion 912–904) PubMed
77.
Chandrasoma PT, Smith MM, Apuzzo ML (1989) Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:160–165PubMedCrossRef
78.
Van Wagenen WP (1931) A surgical approach for the removal of certain pineal tumors. Surg Genecol Obstet 37:216–220
79.
Bruce JN (2000) Posterior third ventricle tumors. In: Kaye AH, Black PM (eds) Operative neurosurgery. Churchill Livingstone, London, pp 769–775
80.
Bruce JN (2012) Management of pineal region tumors. In: Quinones-Hinojosa A (ed) Schmidek and sweet: operative neurosurgical techniques, 6th edn. Elsevier, New York
81.
Bruce JN, Stein BM (1993) Complications of surgery for pineal region tumors. In: Posto KD, Friedman ED, McCormick PC (eds) Postoperative complications in intracranial surgery. Thieme, New York
82.
McComb JG, Apuzzo MLJ (1988) The lateral decubitus position for the surgical approach to the pineal location tumors. Concepts Pediatr Neurosurg 8:186
83.
Ausman JI, Malik GM, Dujovny M, Mann R (1988) Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 29:298–306PubMedCrossRef
84.
85.
Ueyama T, Al-Mefty O, Tamaki N (1998) Bridging veins on the tentorial surface of the cerebellum: a microsurgical anatomic study and operative considerations. Neurosurgery 43:1137–1145PubMedCrossRef
86.
Yu T, Sun X, Wang J, Ren X, Lin N, Lin S (2016) Twenty-seven cases of pineal parenchymal tumours of intermediate differentiation: mitotic count, Ki-67 labelling index and extent of resection predict prognosis. J Neurol Neurosurg Psychiatry 87:386–395. doi:10.​1136/​jnnp-2014-309805 PubMedCrossRef
87.
Farnia B, Allen PK, Brown PD, Khatua S, Levine NB, Li J, Penas-Prado M, Mahajan A, Ghia AJ (2014) Clinical outcomes and patterns of failure in pineoblastoma: a 30-year, single-institution retrospective review. World Neurosurg 82:1232–1241. doi:10.​1016/​j.​wneu.​2014.​07.​010 PubMedCrossRef
88.
Tate M, Sughrue ME, Rutkowski MJ, Kane AJ, Aranda D, McClinton L, McClinton L, Barani IJ, Parsa AT (2012) The long-term postsurgical prognosis of patients with pineoblastoma. Cancer 118:173–179. doi:10.​1002/​cncr.​26300 PubMedCrossRef
89.
Apuzzo M, Tung H (1993) Supratentorial approaches to the pineal region. In: Apuzzo M (ed) Brain surgery: complication avoidance and management. Churchill-Livingstone, New York, p 486
90.
McComb J, Levy M, Apuzzo M (1998) The posterior intrahemispheric retrocallosal and transcallosal approaches to the third ventricle region. In: Apuzzo M (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 743–777
91.
92.
Horrax G (1937) Extirpation of a huge pinealoma from a patient with pubertas praecox. Arch Neurol Psychiatry 37:385–397CrossRef
93.
Bruce J (2006) Pineal region masses: clinical features and management. In: Schmidek H (ed) Operative neurosurgical techniques, 5th edn. Saunders, Philadelphia, pp 786–797
94.
Lapras C, Patet JD (1987) Controversies, techniques and strategies for pineal tumor surgery. In: Apuzzo M (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, p 649
95.
Herrick MK, Rubinstein LJ (1979) The cytological differentiating potential of pineal parenchymal neoplasms (true pinealomas). A clinicopathological study of 28 tumours. Brain 102:289–320PubMedCrossRef
96.
Apuzzo M, Litofsky NS (1993) Surgery in and around the anterior third ventricle. In: Apuzzo M (ed) Brain surgery: complication avoidance and management. Churchill Livingstone, New York, p 541
97.
98.
99.
Vaquero J, Ramiro J, Martinez R, Coca S, Bravo G (1990) Clinicopathological experience with pineocytomas: report of five surgically treated cases. Neurosurgery 27:612–618 (discussion 618–619) PubMedCrossRef
100.
Deshmukh VR, Smith KA, Rekate HL, Coons S, Spetzler RF (2004) Diagnosis and management of pineocytomas. Neurosurgery 55:349–355 (discussion 355–347) PubMedCrossRef
101.
Chang SM, Lillis-Hearne PK, Larson DA, Wara WM, Bollen AW, Prados MD (1995) Pineoblastoma in adults. Neurosurgery 37:383–390 (discussion 390–381) PubMedCrossRef
102.
Rippe DJ, Boyko OB, Friedman HS, Oakes WJ, Schold SC Jr, DeLong GR, Meisler WJ (1990) Gd-DTPA-enhanced MR imaging of leptomeningeal spread of primary intracranial CNS tumor in children. AJNR Am J Neuroradiol 11:329–332PubMed
103.
Waga S, Handa H, Yamashita J (1979) Intracranial germinomas: treatment and results. Surg Neurol 11:167–172PubMed
104.
Shibamoto Y, Abe M, Yamashita J, Takahashi M, Hiraoka M, Ono K, Tsutsui K (1988) Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:285–290PubMedCrossRef
105.
Ueki K, Tanaka R (1980) Treatments and prognoses of pineal tumors—experience of 110 cases. Neurol Med Chir (Tokyo) 20:1–26CrossRef
106.
Dattoli MJ, Newall J (1990) Radiation therapy for intracranial germinoma: the case for limited volume treatment. Int J Radiat Oncol Biol Phys 19:429–433PubMedCrossRef
107.
Disclafani A, Hudgins RJ, Edwards MS, Wara W, Wilson CB, Levin VA (1989) Pineocytomas. Cancer 63:302–304PubMedCrossRef
108.
Linstadt D, Wara WM, Edwards MS, Hudgins RJ, Sheline GE (1988) Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15:291–297PubMedCrossRef
109.
Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MS, Sneed PK (1995) Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32:943–949PubMedCrossRef
110.
Fuller B, Kapp D, Cox RJ (1993) Radiation therapy of pineal region tumors: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys 28:229–245CrossRef
111.
Schild SE, Scheithauer BW, Schomberg PJ, Hook CC, Kelly PJ, Frick L, Robinow JS, Buskirk SJ (1993) Pineal parenchymal tumors. Clinical, pathologic, and therapeutic aspects. Cancer 72:870–880PubMedCrossRef
112.
Chandy MJ, Damaraju SC (1998) Benign tumours of the pineal region: a prospective study from 1983 to 1997. Br J Neurosurg 12:228–233PubMedCrossRef
113.
Kang JK, Jeun SS, Hong YK, Park CK, Son BC, Lee IW, Kim MC (1998) Experience with pineal region tumors. Childs Nerv Syst 14:63–68PubMedCrossRef
114.
Shin HJ, Cho BK, Jung HW, Wang KC (1998) Pediatric pineal tumors: need for a direct surgical approach and complications of the occipital transtentorial approach. Childs Nerv Syst 14:174–178PubMedCrossRef
115.
Bruce J (2016) Pineal tumors. In: Winn HR (ed) Youman & Winn’s neurological surgery, 7th edn. WB Saunders, Philadelphia
116.
Bruce J, Stein B (2000) Supracerebellar infratentorial approach. In: Kaye A, Black P (eds) Operative neurosurgery, vol 1. Churchill Livingstone, London, pp 815–824
117.
Rosenfeld J (2000) Supratentorial approaches to pineal tumors. In: Kaye A, Black P (eds) Operative neurosurgery, vol 1. Churchill Livingstone, London, pp 825–840
Metadata
Title
Microsurgical resection of pineal region tumors
Authors
Adam M. Sonabend
Stephen Bowden
Jeffrey N. Bruce
Publication date
01-11-2016
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 2/2016
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-016-2138-5

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