Operative Experiences in 8 Cases of Pineal Tumor

Kunicki, A

doi:10.3171/jns.1960.17.5.0815

Cited by 55 publications

(11 citation statements)

References 4 publications

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“…Survival rates for patients with pineoblastoma reportedly vary, depending on the modality of treatment, the presence of dissemination or metastasis at diagnosis, and patient age. Early published experience in patients with pineoblastoma supported a conservative approach, whereby patients underwent biopsy or partial resection to establish the diagnosis and to minimize surgical morbidity 7‐9. In the last several decades, advancements in microsurgical techniques and standardization of surgical approaches to the pineal region have provided the impetus to aggressively treat patients with gross total resection (GTR) followed by radiation and chemotherapy 10‐14.…”

Section: Introductionmentioning

confidence: 99%

The long‐term postsurgical prognosis of patients with pineoblastoma

Tate

Sughrue

Rutkowski

et al. 2011

Cancer

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BACKGROUND: For this report, the authors comprehensively summarized the existing literature on patients with pineoblastoma and identified the variables and treatments that had an impact patient on outcomes. METHODS: A comprehensive search identified 109 studies that collectively described the outcomes of patients with pineoblastoma. Individual patient data were classified based on treatment and were subjected to univariate comparisons. Cox regression analysis included comparisons of survival outcomes controlling for age, extent of resection, and treatment group, and between-group survival comparisons were performed using the Kendall tau (rank correlation) statistic. RESULTS: Two hundred ninety-nine patients met inclusion criteria. The overall survival rate was 54% (175 of 299 patients) at a mean follow-up of 31 AE 1.9 months (range, 1-159 months). The analyses demonstrated a markedly worse prognosis for children aged 5 years compared with older patients (5-year survival rate: 15% for children aged 5 years vs 57% for children aged !5 years; log-rank P < .00001). In addition, a graded increase in survival was observed with increasing degrees of resection (5-year survival rate: 84% for patients who underwent gross total resection vs 53% for patients who underwent subtotal resection vs 29% for patients who underwent debulking; logrank P < .0001). Multivariate analysis indicated that not achieving gross total resection markedly worsened patient survival (subtotal resection: hazard ratio, 6.47; 95% confidence interval, 2.3-19; P ¼ .001. debulking: hazard ratio, 9.27; 95% confidence interval, 3.2-27; P < .0001). CONCLUSIONS: The current findings emphasize the importance of aggressive surgical resection in the treatment of pineoblastoma. In addition, the authors conclude that clinical trials should not mix young patients with older patients or patients who undergo subtotal resection with patients who undergo gross total resection, because such heterogeneity may alter the variability of responses to treatment and reduce the likelihood of success. Cancer 2012;118:173-

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Section: Introductionmentioning

confidence: 99%

The long‐term postsurgical prognosis of patients with pineoblastoma

Tate

Sughrue

Rutkowski

et al. 2011

Cancer

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“…During recent years a revival of the techniques for the direct surgical approach to the pineal region has been recommended by Kunicki (1960), Suzuki (1965), Poppen and Marino (1968), Stein (1971), Jamieson (1971), Lazar and Clark (1974), and others. The improvements in nenroanaesthesia, surgical technique, postoperative intensive care, the use of shunt procedures to reduce intracranial pressure before direct attack and the introduction of the surgical microscope, are in our opinion the main factors for achieving safer surgical treatment of these tumours.…”

Section: Surgical Approach To the Pineal Regionmentioning

confidence: 99%

Surgical management of tumours of the pineal region

1976

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Tumours of the pineal region and posterior part of the third ventricle are rare in European and American series (0.5 to 1% of space-occupying lesions). Personal experience is usually limited and thus cooperative studies or critical reviews of reported cases are necessary to establish therapeutic criteria. We have studied 50 cases from our own material of more than 5,000 brain tumours and intracranial space-occupying lesions operated on during the last 30 years. Another 6 verified cases from Dr. F. Isamat, and more than 200 verified tumours from the literature are added. Histological distribution shows that 24% of the tumours in this locality are benign. The different surgical techniques fro reaching the pineal region are reviewed. The results of palliative operations, or partial removals together with radiotherapy, and total removals are presented in 200 verified cases (Table 1), as well as the results obtained by the different surgical approaches (Table 2). Finally, some conclusions are reached regarding the surgical management of these tumours. More than two thirds are radiosensitive, and in about 50 to 70% good results may be obtained with palliative operations and radiotherapy. The remainder of the pineal tumours (about 20%) should be treated by a direct surgical approach. Recent technical improvements and the use of the surgical microscope have reduced the mortality of pineal surgery and allow verification of the histological nature of the tumour in order to establish more rational treatment.

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“…This has led to the conservative approach of radiation and a shunt (Cummins et al, 1960;Cole, 1971). More recently, however, there are reports of single and series of cases where direct surgical exploration was successfully attempted (Kunicki, 1960;Suzuki and Iwabuchi, 1965;Kirsch and Stears, 1970;Sambasivan, 1972). The case reported here emphasizes the need to explore the pineal region surgically.…”

Section: Discussionmentioning

confidence: 81%