Stereotactic Management of Lesions of the Pineal Region

Kreth, Friedrich W.; Schätz, Christoph R.; Pagenstecher, Axel; Faist, Michael; Volk, Benedikt; Ostertag, Christoph B.

doi:10.1097/00006123-199608000-00010

Cited by 109 publications

(45 citation statements)

References 42 publications

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“…21,32,39 Therefore, pathological investigation of the tu mor sample is mandatory before initiation of therapy, especially because there is a choice between surgical and nonsurgical treatment options. 5,11,14,18,21,27,31,32,36,39,41 Although less differentiated tumors such as germinomas are usually highly sensitive to NAT with no need for surgical intervention, 20,21,32 pure mature teratomas, arising from the differentiated cells of the embryonic tridermal plate, are known to respond poorly to NAT, and microsurgery alone can be curative. 5,9,14,25 With an overall 10-year survival rate of 92%, germinomas and mature teratomas belong to the good prognosis group in the classification of Matsutani and colleagues, 32 while secreting lesions typically have a very poor outcome with < 30% of a 3-year survival rate when NAT protocols are followed.…”

Section: Diagnostic and Therapeutic Features Of Intracranial Gctsmentioning

confidence: 99%

Intracranial teratomas in children: the role and timing of surgical removal

Noudel

Vinchon

Dhellemmes

et al. 2008

PED

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Object In this study, the authors report their experience with the surgical treatment of intracranial teratomas with an emphasis on the indications for delayed resection after oncological treatment. Methods The authors retrospectively reviewed the cases of 14 children with intracranial teratomas. The mean age at diagnosis was 10.5 years (range 2 days–18 years), and 11 patients were male. The final histological analysis revealed pure mature teratoma in 5 cases, mixed teratoma with germinoma in 3 cases, and nongerminomatous malignant germ cell tumor in 6 cases. Thirteen patients underwent tumor resection, and these patients were divided into 2 subgroups according to the timing of surgery. In Group A, 10 patients underwent resection as the primary treatment because no tumor markers were detected in 4 patients, a teratomatous component was revealed on biopsy sampling in 3 patients, and a large tumor volume in 3 patients. In Group B, 3 patients underwent removal of residual pure mature teratoma after oncological treatment. Results Seven of the 8 patients (87.5%) with pure mature teratomas or with mixed teratoma and germinoma are currently alive (mean follow-up of 9 years); the eighth patient died of postoperative meningitis. Two of the 6 patients (33%) with mixed nongerminomatous malignant germ cell tumors died of tumor progression regardless of the timing of surgery. Conclusions The results of this study support the belief that microsurgical removal is the only effective treatment for intracranial teratomas. Surgery may be performed as the primary therapy when there is evidence of a noninvasive teratoma, and as a secondary therapy if there is only a partial response to neoadjuvant therapy or if progression is observed in mixed malignant germ cell tumors.

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Section: Diagnostic and Therapeutic Features Of Intracranial Gctsmentioning

confidence: 99%

Intracranial teratomas in children: the role and timing of surgical removal

Noudel

Vinchon

Dhellemmes

et al. 2008

PED

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“…For an accurate histological diagnosis, sample tissue should be obtained by surgical intervention from the mass. Stereotactic biopsy rather than open surgery may be adequate only for establishing the histological diagnosis of pineal tumors 18,26,33 . Therapeutic approach can be determined based on histopathological diagnosis.…”

Section: Resultsmentioning

confidence: 99%

“…So the primary objective of surgical management of pineal region tumors is the establishment of an accurate histological diagnosis by examination of the tissue obtained by surgical intervention. Stereotactic biopsy rather than open surgery may be adequate investigation of a pineal region mass 18,24,26 in patients with poor medical condition.…”

Section: Discussionmentioning

confidence: 99%

Lung carcinoma metastasis presenting as a pineal region tumor

et al. 2011

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SummaryThe pineal region is an unusual site for brain metastasis and most metastatic pineal lesions are asymptomatic. A 53 year-old man presented with severe headache, limitation of upward gaze and diplopia. The patient's neurological examination was unremarkable. Magnetic resonance imaging (MRI) scans of the brain demonstrated a 1,5 x 2 cm well demarcated solitary mass in the pineal region with hydrocephalus. Surgery was performed and adenocarcinoma was diagnosed. A systemic investigation revealed adenocarcinoma of the lung as primary lesion. Although rare, metastatic tumor should be considered in the differential diagnosis of pineal region tumors. KEY WORDS. Pineal region. Metastasis. Lung carcinoma. MRI. Pineal tumor. Metástasis del carcinoma de pulmón que se presenta como tumor de la región pineal ResumenLa región pineal es un sitio inusual para el depósito de metástasis y la mayoría de las metástasis pineales son asintomáticas. Un hombre de 53 años debutó con una cefalea intensa, limitación en la supraversión y diplopia. La exploración neurológica fue irrelevante. La resonancia magnética (RM) cerebral demostró una lesión solitaria de 1,5 x 2 cm bien delimitada, en la región pineal con hidrocefalia. Fue intervenido quirúrgicamente siendo el diagnóstico anatomopatológico de adenocarcinoma. Un estudio sistémico descubrió un adenocarcinoma de pulmón como tumor primario. Aunque muy raramente, las metástasis deben considerarse en el diagnóstico diferencial de tumores de la región pineal.

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“…5) Metastasis of malignant neoplasms to the pineal gland is very rare, and accounts for only 3.8% 10) of all pineal region tumors and only 0.4% 5) to 3.8% 14) of all metastatic intracranial tumors. Most such metastases were diagnosed posthumously.…”

Section: Introductionmentioning

confidence: 99%

“…5) To date, approximately 180 metastatic tumors of the pineal region have been reported but discovery was posthumous in most cases. 1,[3][4][5][6][7][8][9][10][11][12][14][15][16][17][18][19][20][21] Table 1 summarizes the clinical features of 33 reported cases with metastases in the pineal gland that were symptomatic and diagnosed in life. The mean age of the patients was 58.3 ± 12.5 years.…”

mentioning

confidence: 99%

Metastatic Pineal Tumors Treated by Neuroendoscopic Surgery -Two Case Reports-

Hanada

Oyoshi

Hirano

et al. 2010

Neurol. Med. Chir.(Tokyo)

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Two patients presented with metastatic pineal tumors. A 69-year-old man had gait disturbance, dementia, and urinary incontinence but no history of previous malignancy. Magnetic resonance imaging of the brain revealed a 23-mm tumor in the pineal region and obstructive hydrocephalus. A 37-year-old man had been treated for thyroid cancer. He presented with vomiting and consciousness disturbance. Brain magnetic resonance imaging revealed a 28-mm pineal tumor associated with intratumoral hemorrhage and accompanying obstructive hydrocephalus. Both patients underwent neuroendoscopic biopsy and third ventriculostomy through the foramen of Monro, resulting in reliable histological diagnoses and subsidence of hydrocephalus.

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Stereotactic Management of Lesions of the Pineal Region

Cited by 109 publications

References 42 publications

Intracranial teratomas in children: the role and timing of surgical removal

Intracranial teratomas in children: the role and timing of surgical removal

Lung carcinoma metastasis presenting as a pineal region tumor

Metastatic Pineal Tumors Treated by Neuroendoscopic Surgery -Two Case Reports-

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