Quality of life following surgical treatment of lesions within the pineal region

Abstract

OBJECTIVE Pineal region tumors are a rare and heterogeneous group of lesions. The optimal therapeutic approach is currently a topic of controversy, particularly in light of the potential operative risks and complications. The potential beneficial effects of surgery have already been described, but information about neurological outcome and, in particular, health-related quality of life (HRQOL) is still lacking in the literature. The aim of this study was to assess the therapeutic effect of resection of pineal region lesions, emphasizing grade of tumor resection, neurological outcome, quality of life, and the necessity of additional shunt procedures. METHODS The authors performed a prospective study of HRQOL in 32 patients who had undergone surgical treatment of lesions in the pineal region (20 tumors and 12 cysts) between 2008 and 2014. All patients had at least 6 months of follow-up, with reexamination including standardized neurological assessment, an evaluation of dependency using the modified Rankin Scale, and an evaluation of HRQOL. The authors retrospectively examined patient charts and collected information regarding imaging studies, neurological status prior to surgery, surgical strategies used, any complications, and histological diagnoses. RESULTS In this study, there was no surgery-associated mortality or major morbidity. Permanent minor morbidity was reported for 4 patients (13%). Comparing pre- and postoperative neurological symptoms, 75% of tumor patients had either complete resolution or improvement of preoperative symptoms; symptoms were unchanged in 10% of tumor patients and deteriorated in 15%. In patients with pineal cysts, long-term follow-up showed that 42% of patients were free of any symptoms and 58% experienced improvement of their preoperative symptoms. These outcomes were also reflected in the modified Rankin Scale scores, which demonstrated significant improvement following resection of pineal region lesions. Furthermore, significant improvements in HRQOL scores occurred in global health status, in all functional scales, and in pain, nausea and vomiting, fatigue, and insomnia (p < 0.0001). Moreover, a significant reduction in the necessity for permanent shunt procedures was observed after gross-total tumor resection compared with subtotal resection (p = 0.035) of pineal cysts. CONCLUSIONS Despite potential risks, (radical) surgery is a highly effective and safe treatment option for pineal region lesions and should be considered for the majority of patients.

The microsurgical management of benign pineal cysts: Helsinki experience in 60 cases

“…Table 5 lists the most relevant series (series with >10 pineal cysts) of the surgically treated pineal cyst from literature. [4,15,17,18,25,29-31,33] Similarly to the previously published series, our surgically treated pineal cysts are predominantly encountered in young females between the second and the third decades of life. [22,32,34,44] Four patients were <10 years old and were operated on due to the solid appearance of their pineal lesion which was suspected to be a solid primary tumor.…”

Management of pineal region tumors in a pediatric case series

“…Ongoing progress in the field of microsurgery has subsequently lowered complication rates of these complex interventions. There are recent reports about primary microsurgical resection of pineal tumors with low experienced complications and improved function without prior biopsy [ 10 , 12 , 17 , 29 ]. In some of those series, no tumor of the germ cell type group was specifically mentioned [ 10 , 17 ].…”

“…There are recent reports about primary microsurgical resection of pineal tumors with low experienced complications and improved function without prior biopsy [ 10 , 12 , 17 , 29 ]. In some of those series, no tumor of the germ cell type group was specifically mentioned [ 10 , 17 ]. Still, permanent “minor” morbidity—double vision, hypacusis, and cerebellar symptoms—was reported for 13% of patients [ 10 ].…”

Systematic review of pineal cysts surgery in pediatric patients

“…PCs in the general population are mostly considered normal anatomical variations and the Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00381-020-04792-3) contains supplementary material, which is available to authorized users. parameters to define pathological PCs in need of treatment are currently unestablished [10][11][12][13][14][15][16][17][18][19][20][21].…”

“…As such, surgically treated pediatric PCs may represent a different and unique entity in clinical practice, which has not previously been properly investigated. Only a few large series on surgically treated PCs have been published in recent years [10][11][12][13][14][15][16][17][18][19][20][21][22], and no clinical study on surgically treated PCs in pediatric patients has been reported thus far. In 2013, a review on surgically treated PCs in children was performed.…”