Microsurgical management of pineal region lesions: personal experience with 119 patients

Hernesniemi, Juha; Romani, Rossana; Albayrak, Baki S.; Lehto, Hanna; Dashti, Reza; Ramsey, Christian N.; Karataş, Ayşe; Cardia, Andrea; Navrátil, Ondřej; Piippo, Anna; Fujiki, Minoru; Toninelli, Stefano; Niemelä, Mika

doi:10.1016/j.surneu.2008.07.019

Cited by 130 publications

(87 citation statements)

References 56 publications

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“…5,6 Contrary to previous suggestions that Parinaud's syndrome resolves quickly following treatment, we found that persistent posttreatment visual morbidity is common. 4 At the time of the last ophthalmological assessment, 76% of patients showed some lasting ocular mobility disturbance, with 62% having partial Parinaud's syndrome.…”

Section: Discussioncontrasting

confidence: 99%

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Ophthalmological outcomes of patients treated for pineal region tumors

Hankinson¹,

Lyons

Hukin

et al. 2016

PED

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OBJECTIVE The ophthalmological outcomes of children treated for pineal tumors have received limited attention in the literature. METHODS This paper reviews the outcomes of 29 children treated for pineal and posterior third ventricular tumors in the contemporary era using chemotherapy, radiotherapy, and resection as defined by the histology and/or marker profile of the tumor. RESULTS At the time of diagnosis, all patients except 1 had hydrocephalus and all had ophthalmological involvement. Papilledema was found in 69% of patients. Seventy-five percent of patients had partial or complete Parinaud's syndrome, and diplopia or blurred vision was noted in the remaining patients. Visual acuity was impaired in 8 patients. Outcomes were dependent on the histology of the tumor and the treatment required. Those patients who did not requiring resection showed a lower rate of ophthalmological worsening during treatment and greater long-term improvement, in particular with respect to up-gaze palsy. Patients who underwent resection for postchemotherapy residual disease or primary resection showed greater worsening during treatment and lesser degrees of recovery. All patients with impaired visual acuity improved with treatment. CONCLUSIONS As the mortality of germ cell and other pineal tumors decreases, posttreatment morbidity remains, specifically that related to convergence nystagmus, accommodation, and diplopia. In addition to survival, ophthalmological morbidity should be reported in studies concerning the outcomes of treatment for pineal neoplasms.

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Section: Discussioncontrasting

confidence: 99%

“…5,7,10 These reports contrast our data and that of others. The reasons for this difference is not apparent as reports do not provide detailed ophthalmological outcomes.…”

Section: Discussioncontrasting

confidence: 99%

Ophthalmological outcomes of patients treated for pineal region tumors

Hankinson¹,

Lyons

Hukin

et al. 2016

PED

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“…Modern series now report an incidence of complications, usually defined as conjugate morbidity and mortality data, of between 10% and 15%. 3,5 Myriad surgical approaches have been described, with the 2 most common being the supracerebellar infratentorial and occipital transtentorial. 12 Ophthalmological signs and symptoms associated with tumors of the pineal gland are classically summarized by the eponymous syndrome of Parinaud.…”

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confidence: 99%

Ophthalmological outcome after resection of tumors based on the pineal gland

Hart¹,

Sarkies

Santarius³

et al. 2013

JNS

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Object Descriptions of visual dysfunction in pineal gland tumors tend to focus on upward gaze palsy alone. The authors aimed to characterize the nature, incidence, and functional significance of ophthalmological dysfunction after resection of tumors based on the pineal gland. Methods Review of a retrospective case series was performed and included consecutive patients who underwent surgery performed by a consultant neurosurgeon between 2002 and 2011. Only tumors specifically based on the pineal gland were included; tumors encroaching on the pineal gland from other regions were excluded. All patients with visual signs and/or symptoms were reviewed by a specialist consultant neuroophthalmologist to accurately characterize the nature of their deficits. Visual disturbance was defined as visual symptoms caused by a disturbance of ocular motility. Results A total of 20 patients underwent resection of pineal gland tumors. Complete resection was obtained in 85%, and there were no perioperative deaths. Visual disturbance was present in 35% at presentation; of those who had normal ocular motility preoperatively 82% had normal motility postoperatively. In total, 55% of patients had residual visual disturbance postoperatively. Although upward gaze tended to improve, significant functional deficits remained, particularly with regard to complex convergence and accommodation dysfunction. Prisms were used in 25% but were only ever partially effective. Visual outcome was only related to preoperative visual status and tumor volume (multivariate analysis). Conclusions Long-term visual morbidity after pineal gland tumor resection is common and leads to significant functional impairment. Improvement in deficits rarely occurs spontaneously, and prisms only have limited effectiveness, probably due to the dynamic nature of supranuclear ocular movement coordination.

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“…Due to the close vicinity of the deep venous system and the mesencephalo-diencephalic structures, surgical management remains challenging. In a series of 119 patients with tumors of the pineal region of different histological entities in whom resection was attempted, surgical mortality was 0%, but morbidity was 18%, including cranial nerve palsies, hemiparesis, Parinaud's syndrome and memory disturbances [7]. Another series of 160 cases harboring pineal region tumors reports an operative mortality of 4% with a 3% permanent major morbidity [8].…”

Section: Discussionmentioning

confidence: 99%

Stereotactic Radiosurgery of a Papillary Tumor of the Pineal Region: Case Report and Review of the Literature

Riis¹,

Eck²,

Dunker

et al. 2013

Stereotact Funct Neurosurg

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Background/Aims: Papillary tumors of the pineal region are a recently described very rare group of primary CNS neoplasms. Because of their rarity, it has proven to be difficult to establish the optimal therapy. Furthermore, microsurgical resection of pineal region neoplasms is associated with quite a high morbidity. We report the first case of stereotactic radiosurgery of a histologically confirmed papillary tumor of the pineal region. Methods: After establishing the diagnosis by stereotactic biopsy, the patient was treated with stereotactic radiosurgery in a Gamma Knife unit. Results: Five years after treatment, the tumor size is still decreasing, showing a good response to the treatment. Conclusions: Stereotactic radiosurgery should be considered a treatment option in these surgically challenging tumors.

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Microsurgical management of pineal region lesions: personal experience with 119 patients

Cited by 130 publications

References 56 publications

Ophthalmological outcomes of patients treated for pineal region tumors

Ophthalmological outcomes of patients treated for pineal region tumors

Ophthalmological outcome after resection of tumors based on the pineal gland

Stereotactic Radiosurgery of a Papillary Tumor of the Pineal Region: Case Report and Review of the Literature

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