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

Abstract

Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.

Plasma miRNA expression profile in pediatric pineal pure germinomas

“…The risk of lasting morbidity from open resection is 3% to 10%, while mortality rates range from 4% to 10%. Meanwhile, the mortality and morbidity rates for stereotactic biopsy of the pineal region range between 1% and 1.3% ( 36 ). Finding a blood and/or CSF biomarker for pure germinomas would offer many benefits, and circulating microRNAs hold great clinical promise in this area ( 37 ).…”

Pituitary germinoma after resection of a mature third ventricular teratoma: illustrative case

“…Sampling errors, potentially leading to a false diagnosis, occur due to the heterogeneity of iGCTs, ultimately affecting treatment and prognosis. 33 However, endoscopic biopsy shows a diagnostic yield of up to 95.8% with relatively low permanent morbidity rates. 34 , 35 To note, technical expertise in endoscopic surgery is required to achieve a high diagnostic yield.…”

Diagnosis and Management of Pineal Germinoma: From Eye to Brain

“…43 Brain-Related Non-Ocular, Non-Endocrinologic Findings Headache is a hallmark symptom of elevated ICP. Headache occurs commonly in patients with germinoma (88.3% of patients in 1 series), 44 usually related to hydrocephalus. If not treated, disease progression can lead to "hydrocephalic fits", associated with posturing and coma.…”