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[Pineal region surgery. Experience in 22 patients].
S Hancq1, O De Witte, J Brotchi
1Service de Neurochirurgie, Hôpital Erasme, Université Libre de Bruxelles, 808, route de Lennik, B-1070 Bruxelles, Belgique.
Neuro-Chirurgie
|April 25, 2002
Summary
This study evaluated occipitoparietal and infratentorial supracerebellar approaches for pineal region tumors, finding low morbidity and mortality. Surgical approach selection is key for successful resection of these complex lesions.
Area of Science:
- Neurosurgery
- Oncology
- Radiology
Background:
- Pineal region tumors present surgical challenges with historically high morbidity and mortality.
- Direct neurosurgical approaches offer potential for tumor resection.
Purpose of the Study:
- To report experience with occipitoparietal and infratentorial supracerebellar approaches for pineal region lesions.
- To evaluate the safety and efficacy of these surgical techniques.
Main Methods:
- Retrospective review of 25 operations in 22 patients between 1986 and 1997.
- Utilized CT-scan, conventional angiography, and magnetic resonance imaging with angiographic study (angio-MRI).
- Employed occipitoparietal (n=14) or infratentorial supracerebellar (n=8) approaches; 3 patients had stereotactic biopsy.
Main Results:
- Low mortality and morbidity observed compared to literature data.
- Two patients experienced worsened outcomes: hemianopsia (occipitoparietal) and temporary Parinaud syndrome (supracerebellar infratentorial).
- One patient died postoperatively from pulmonary embolism.
Conclusions:
- Direct neurosurgical approaches allow for total or partial resection of pineal region lesions with low morbidity.
- The choice of surgical approach (occipitoparietal vs. infratentorial supracerebellar) depends on lesion characteristics.
- Angiographic MRI is valuable for surgical planning, assessing lesion relationship to deep veins.