The value of endoscopy in the total resection of pineocytomas

Pineocytomas are rare pineal region tumors. The mainstay of treatment for pineocytomas is total surgical resection.

To address the worthiness of endoscopy to achieve total macroscopic resection and whether or not this portends better progression-free and overall survival.

A series of 15 patients (11 females, 4 males; mean age, 48 years) with histological diagnosis of pineocytoma were retrospectively reviewed. All patients underwent an attempt at total resection via an interhemispheric/transtentorial/retrosplenial approach. The endoscope was used at various times throughout the case and consistently at the end to evaluate any possible residual tumor. No patient in this series was given radiotherapy after surgery.

There was no surgical mortality and all patients are currently alive without recurrence (mean follow-up, 4.28 years). A macroscopic and radiological complete removal was achieved in all cases. There was only one patient with permanent neurological deficit (disconjugate eye movements). Two patients (13%) had transient poor sleep pattern, 5 patients (33%) had transient disconjugate eye movements, and 2 patients (13%) had transient short-term memory disturbance. In 6 cases (40%), the endoscope was able to detect residual tumor located either behind the Vein of Galen or attached to the undersurface of the corpus callosum. Residual tumor was then resected using a 30 degrees endoscope and dedicated angled endoscopic instruments.

This series demonstrates the advantage of endoscopic-assisted surgery in the total removal of pineocytomas. With total removal of these histologically benign tumors patients may enjoy extended progression-free survival without adjuvant radiotherapy.