TechniqueMicrosurgical management of pineal region lesions: personal experience with 119 patients
Section snippets
Introduction and historical background
Every man owes it a debt to his profession to put on record whatever he has done that might be of use to others.
Francis Bacon (1561-1626) [20]
The deep site of the pineal region surrounded by vital structures was long considered inaccessible for surgery. The first neurosurgical approaches performed by Horsley, Brummer, and Schloff had disastrous consequences [6], [7], [78]. Oppenheim and Krause reported the first successful removal of a pineal tumor removal in 1913 [40], [53]. Dandy [17]
Patient population
We retrospectively reviewed the case histories of all 119 consecutive patients with pineal lesions who were operated on by the senior author (JH) between 1980 and 2007 (1980-1997 Kuopio, 1997-2007 Helsinki).
Of these 119 patients, 14 (12%) were younger than 16 years. The patients' mean age was 34 years (0-78 years). Sixty-eight patients (57%) were women.
The mean follow-up was 40 months (6-60 months).
Preoperative clinical signs and symptoms
Signs of increased intracranial pressure were observed in 71 patients (60%), and 26 patients
Results
The data were obtained from the patients' charts during hospitalization or ambulatory consultation. In addition, we analyzed all surgical videos that are routinely made during every (micro)surgical operation. Follow-up information is received from the patients' general practitioner if it was indicated.
Discussion
To the best of our knowledge, we present one of the largest consecutive surgical series of pineal region tumors that are microsurgically treated and published.
The presenting clinical findings in our patient population were similar to those in other large series, including mild headache, Parinaud syndrome, hemisyndromes, cerebellar findings, and cognitive/memory impairment [1], [5], [7], [11], [21], [24], [29], [32], [34], [37], [45], [49], [62], [71]. These manifestations were related to
Conclusions
The ITSC route is a safe and effective surgical approach for pineal region tumor, associated with low morbidity, complete lesion removal, and definitive histopathologic diagnosis. Because of this good postoperative outcome, routine stereotactic biopsy is no more mandatory before pineal tumor removal. In most cases, direct surgical treatment can be offered as the first treatment option for pineal tumors.
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2022, World NeurosurgeryCitation Excerpt :Hence, in patients with undefined pineal masses, a full metastatic workup should be performed. In this review, most patients underwent only biopsy (65.9%), contrary to previous large series of mixed pineal region tumors reporting higher rates of surgical resection.12,13 These differences may be caused by the poor surgical eligibility of patients with pineal metastases, often presenting with known systemic diseases and/or severe comorbidities.