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Pineal region tumors in children
M S Edwards1, R J Hudgins, C B Wilson
1Department of Neurological Surgery, School of Medicine, University of California, San Francisco.
Journal of Neurosurgery
|May 1, 1988
Summary
Definitive surgery with histological diagnosis is the preferred treatment for pediatric pineal region tumors. Conservative approaches are no longer appropriate, with surgery showing low mortality and acceptable morbidity for these rare childhood brain tumors.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Neuro-oncology
Background:
- Pineal region tumors in children are rare and diverse.
- Historically, conservative management (shunting, radiation) was used.
- Advancements in surgical techniques necessitate re-evaluation of treatment paradigms.
Purpose of the Study:
- To evaluate the efficacy of surgical treatment for pediatric pineal region tumors.
- To compare outcomes based on tumor histology.
- To assess the role of diagnostic tools like MRI and CSF markers.
Main Methods:
- Retrospective review of 36 children (under 18) treated between 1974-1986.
- Analysis of presentation, treatment (surgery, radiation), and outcomes.
- Utilized cerebrospinal fluid (CSF) tumor markers (alpha-fetoprotein, beta-human chorionic gonadotropin) and Magnetic Resonance Imaging (MRI).
Main Results:
- Surgery was performed on 30 patients with no operative deaths and 10% persistent morbidity.
- Germinomas (11 patients): 82% alive without recurrence; astrocytomas (7 patients): 86% well after biopsy and radiation.
- MRI identified tumors missed by CT scans; CSF markers aided in diagnosing malignant germ-cell tumors.
Conclusions:
- Definitive surgery with histological diagnosis is the preferred treatment for pediatric pineal region tumors.
- Conservative management is no longer considered appropriate.
- Biopsy diagnosis is crucial due to tumor diversity; preoperative CSF markers and imaging aid prognosis and surgical planning.