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Pineal region tumors--neurosurgical review
Ivan Radovanovic1, Kemal Dizdarevic, Nicolas de Tribolet
1Division of Neurosurgery, Geneva University Hospital, University of Geneva, Switzerland.
Abstract:
The treatment for the pineal region tumors depends on tumor histology. Nowadays, germinomas can be cured by radiotherapy and chemotherapy without surgical resection but the other pineal region tumors should be primary treated by surgery. Two microsurgical approaches, the infratentorial supracerebellar and the occipital transtentorial, are accepted as the main standard accesses to the pineal region. For benign pineal tumors (pineocytoma, meningioma, mature teratomas, symptomatic pineal cysts, etc.) radical surgical resection can be curative. For malignant tumors radical surgical resection is not an objective. Serum and CSF markers contribute to the diagnosis of pineal parenchymal tumors. b-HCG is mainly positive in choriocarcinomas, embryonal carcinomas and mixed germ cell tumors and AFP is expressed by yolk sac tumors, embryonic carcinomas, immature teratomas and mixed germ cell tumors, b-HCG is usually low in germinomas which are often positive for PLAP on immunohistochemistry. Fifty-one pineal region tumors were surgically treated by senior author (NdT). Only 17 of them were the neoplasms originating from pineal body (pineal tumors). In conclusion it can be stressed that management of pineal tumors requires a multidisciplinary cooperation. With the exception of germinoma where only a biopsy is needed, the role of the surgeons still remains prominent as resection of pineal tumors requires high technical skill and experience as well as precise clinical judgment.
Insights
Pineal region tumor treatment varies by histology. Surgery is key for most tumors, except germinomas, which respond to chemotherapy and radiotherapy. Multidisciplinary care ensures optimal patient outcomes.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Pineal region tumors encompass diverse histologies requiring tailored treatment strategies.
- Germinomas are curable with non-surgical methods, while other tumors necessitate primary surgical intervention.
- Standard microsurgical approaches include infratentorial supracerebellar and occipital transtentorial routes.
Purpose of the Study:
- To outline the diagnostic and therapeutic strategies for pineal region tumors.
- To emphasize the role of surgical resection in managing various pineal region pathologies.
- To highlight the importance of multidisciplinary collaboration in treating these complex neoplasms.
Main Methods:
- Review of surgical treatments for 51 pineal region tumors, with a focus on 17 primary pineal tumors.
- Analysis of diagnostic markers, including serum and cerebrospinal fluid (CSF) markers like b-HCG, AFP, and PLAP.
- Application of microsurgical techniques for tumor resection.
Main Results:
- Radical surgical resection offers curative potential for benign pineal tumors (e.g., pineocytoma, meningioma).
- Malignant pineal tumors require different management strategies, as complete resection is often not feasible.
- Tumor markers (b-HCG, AFP, PLAP) aid in differentiating pineal parenchymal tumors and guiding treatment.
Conclusions:
- Management of pineal region tumors demands a multidisciplinary approach.
- Surgical expertise is crucial for pineal tumor resection, except for germinomas requiring biopsy only.
- Accurate diagnosis and skilled surgical judgment are paramount for successful treatment outcomes.
