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Surgical approach to pineal tumours
F Pluchino1, G Broggi, M Fornari
1Department of Neurosurgery, Istituto Neurologico C. Besta, Milano, Italy.
Insights
This study analyzed 40 pineal region tumors treated over 10 years, finding many in young patients. A new protocol improved diagnosis and treatment, guiding surgical or radiation strategies based on tumor type.
Area of Science:
- Neurosurgery
- Pediatric Oncology
- Neuroradiology
Background:
- Pineal region tumors are rare and often present in pediatric and juvenile populations.
- Accurate diagnosis and tailored treatment are crucial for managing these complex lesions.
Purpose of the Study:
- To evaluate the outcomes of a diagnostic and therapeutic protocol for pineal region tumors.
- To analyze the efficacy of different treatment modalities based on histological diagnosis.
Main Methods:
- Retrospective analysis of 40 pineal region tumor cases treated between 1977 and 1986.
- Implementation of a specific protocol since 1983 involving stereotactic biopsy for initial diagnosis.
- Surgical excision using the infratentorial supracerebellar approach for selected cases.
- Radiotherapy and/or chemotherapy for malignant or unresectable tumors.
Main Results:
- A significant proportion (67.5%) of tumors occurred in patients aged 10-20 years.
- The protocol led to tailored treatments: 25% benign resectable tumors, 25% low-grade astrocytomas, 30% radiosensitive lesions, and 20% highly malignant tumors.
- The infratentorial supracerebellar approach was consistently used for surgical interventions.
Conclusions:
- A diagnostic protocol guiding treatment selection is effective for pineal region tumors.
- Treatment strategies should be individualized based on histological findings, ranging from surgical resection to radiotherapy and chemotherapy.
- The infratentorial supracerebellar approach is a viable surgical option for pineal region tumor removal.
Abstract:
During a period of 10 years (1977-1986) 40 cases of tumour of the pineal region have been treated at the Istituto Neurologico "C. Besta"-of Milan. Out of these 40 cases, 27 (67.5%) were in the paediatric (10-15 years) or juvenile (15-20 years) age at the time of operation. Since 1983 a specific diagnostic and therapeutic protocol has been adopted and thereafter direct surgical removal of the tumour was performed only when the neuroradiological investigations were highly suggestive of a benign extrinsic lesion. Sixteen cases in this series underwent direct surgical removal; in the remaining 24 cases stereotactic biopsy of the tumour was performed in the first instance. On the basis of the histological diagnosis obtained by this procedure surgical excision of the tumour (9 cases) or radiotherapy (15 cases) was then performed. 25 cases underwent surgical removal of the lesion. In all the cases the infratentorial supracerebellar approach as introduced by Krause and then modified by Stein was adopted. On analysis of the data of this series it was observed that in 25% of the cases completely benign resectable tumours were found; in 25% of the cases astrocytoma (grade I-II) which could be treated at least by partial removal were present; in 30% of the cases radiosensitive lesions were encountered. In the remaining 20% of the cases highly malignant tumours were found which should be treated only by radiotherapy and/or chemotherapy.