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Treatment of Pineal Region Lesions in Children
Li-Tian Huang1, Quan Zhou2, Xiaoguang Tong1
1Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin.
Insights
Pediatric pineal region lesion treatment is controversial. Total resection and radiotherapy improve outcomes, while endoscopic third ventriculostomy (ETV) effectively manages hydrocephalus, leading to better prognoses.
Area of Science:
- Pediatric neurosurgery
- Pediatric oncology
- Pediatric neurology
Background:
- Pineal region lesions are more prevalent in children than adults.
- Therapeutic strategies for pediatric pineal region lesions remain a subject of debate.
Purpose of the Study:
- To analyze therapeutic strategies for pediatric pineal region lesions and associated hydrocephalus.
- To identify factors influencing outcomes in pediatric patients with pineal region lesions.
Main Methods:
- Retrospective analysis of 54 pediatric patients with pineal region lesions.
- Classification and evaluation of treatment strategies for both lesions and hydrocephalus.
Main Results:
- Radiotherapy demonstrated better short-term postoperative recovery and fewer complications than lesion resection.
- Total resection correlated with smaller lesion size, endoscopic approaches, and improved prognosis.
- Endoscopic third ventriculostomy (ETV) emerged as an effective strategy for hydrocephalus management, with lesion size and intracranial complications predicting outcomes.
Conclusions:
- Total resection and radiotherapy are crucial for treating pediatric pineal region lesions.
- Preoperative cerebrospinal fluid (CSF) diversion and achieving total resection are beneficial, while further resection negatively impacts CSF diversion.
- ETV is the preferred method for pediatric hydrocephalus, and lesion size/intracranial complications are key prognostic indicators.
Background:
Pineal region lesions are more common in children than adults; however, therapeutic strategies for pineal region lesions in children are controversial.
Methods:
A retrospective study involving 54 pediatric with pineal region lesions was conducted. The therapeutic strategies for lesions and hydrocephalus were classified and analyzed.
Results:
Radiotherapy of pineal region lesions was shown to result in better postoperative recovery and fewer complications in the short-term compared with lesion resection. Total resection was related to smaller lesion size, endoscopic procedures, and a better prognosis. Cerebrospinal fluid (CSF) diversion before the resection reduced hydrocephalus recurrences, whereas further lesion resection had a negative short-term influence on CSF diversion. Among the 4 therapeutic strategies to manage hydrocephalus, a third ventriculostomy (ETV) was reasonable and further resection did not have a negative impact on the ETV. The relief of hydrocephalus was also related to better postoperative recovery, a higher total resection rate, fewer complications, and a better prognosis. Logistical regression analysis indicated that lesion size and intracranial complications were predictors of outcome.
Conclusions:
For lesion treatment, total resection and radiotherapy are essential components in children. Total resection and CSF diversion before resection were beneficial, whereas further lesion resection had a negative impact on CSF diversion. For hydrocephalus treatment, ETV was shown to be the best therapeutic strategy for management of pediatric hydrocephalus. Total resection and better preoperative health status were associated with greater hydrocephalus relief. For the overall prognosis, a lack of hydrocephalus relief was associated with poor outcomes. Lesion size and intracranial complications may be the best predictors of outcome.
