Long term outcomes following surgery for pineal region tumors

Shepard, Matthew J.; Haider, Ali S; Prabhu, Sujit S.; Sawaya, Raymond; DeMonte, Franco; McCutcheon, Ian E.; Weinberg, Jeffrey S.; Ferguson, Sherise D.; Suki, Dima; Fuller, Gregory N.; Lang, Frederick F.

doi:10.1007/s11060-021-03919-z

Cited by 13 publications

(10 citation statements)

References 24 publications

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“…Indeed, benign pineal region lesions can be cured by surgical resection and the survival time of patients with malignant pineal region lesions can be increased 8,16 . Therefore, most surgeons believe that surgical resection promotes the quality of life and outcomes of patients with pineal region lesions 17–19 . The resected lesion provides sufficient tissue for accurate pathologic diagnosis and relieves the lesion burden 3 .…”

Section: Discussionmentioning

confidence: 99%

Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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Background: Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial. Methods: A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed. Results: Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome. Conclusions: For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.

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Section: Discussionmentioning

confidence: 99%

Treatment of Pineal Region Lesions in Children

Huang,

Zhou,

Tong

2023

Journal of Craniofacial Surgery

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“…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 ]. The finding of a 43% complication rate after resection within the SIOP CNS GCT 96 trial could be related to its multicenter/multisurgeon database.…”

Section: Discussionmentioning

confidence: 99%

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

Shabo

Czech

Nicholson

et al. 2022

Cancers

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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.

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“…In a recent retrospective study, Shepard et al analyzed the surgical and oncologic outcomes of 68 patients who underwent surgery for a pineal region tumor [ 69 ]. The mean age at surgery was 30.9 ± 15.3 years, pre-operative hydrocephalus was present in 83.8% of cases, the median pre-operative Karnofsky Performance Status (KPS) was 90.…”

Section: The Role Of Surgerymentioning

confidence: 99%

“…Gross total resection, low grade tumors and improved performance status were associated with improved overall survival. Due to the small number of cases, no analysis was performed to assess the impact of histopathology on overall survival [ 69 ].…”

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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Long term outcomes following surgery for pineal region tumors

Cited by 13 publications

References 24 publications

Treatment of Pineal Region Lesions in Children

Treatment of Pineal Region Lesions in Children

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

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

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