Surgical management of tumours of the pineal region

Abstract

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.

Meningiomas of the velum interpositum: surgical considerations

“…19,24,25,28,36,40,43,46,51,53 Variable degrees of tumor blush were observed in nine cases. The PChAs supplied the tumor in all cases; in only one case was the medial PChA not visualized.…”

Gangliocytoma of the pineal body a case report and review of the literature

“…Germinomas and teratomas are common, and gliomas, ependymomas, epidermoid and dermoid tumours, meningiomas, and angiomatous malformations are occasionally encountered:, 15,26 Recently we have experienced a gangliocytoma in the pineal region where this tumour is most unlikely to occur, and have succeeded in a total removal of it. The case is presented here with its clinical features, our diagnosis, operative technique and pathological findings, together with a review of the literature.…”

Pineal chordoid meningioma complicated by repetitive hemorrhage during pregnancy: Case report and literature review

“…Pineal region tumors account for less than 1% of all intracranial tumors, and pineal meningiomas are even more uncommon, constituting 6.2–8.0% of all pineal region tumors 1,2 . Chordoid meningioma is a rare subtype of meningioma characterized by chordoma‐like histologic features, named by Kepes et al .…”