Management of pineal region tumours

Pineal region tumours represent a colourful, challenging peculiarity of brain pathology. Views on their management are still much divided and controversial. Data of fifty patients with the whole palette of these tumours seen in the National Institute of Neurosurgery have been analysed in view of the result of management versus histology of these tumours. Findings of tumour marker studies have not at all been conclusive in predicting histology and outcome, however, cytology of the cerebrospinal fluid (CSF), if positive, pointed toward a very gloomy management result in all cases. Merits of infratentorial-supracerebellar, occipito-transtentorial approaches of direct surgery, palliative interventions and their timing, as well as that of irradiation are discussed in comparison with opinions and arguments from the literature. Shunt procedures alone proved to be dangerous in some cases by evoking haemorrhagic complications. In carefully selected cases microsurgical intervention gave the best possible results in expansively growing pineal region tumours. There is still place for irradiation and chemotherapy, again, in certain types of mass lesions.