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Pineal Tumor Surgery-The Choice of the Approach Related to Tumor Characteristics and Posterior Fossa Anatomy
Filip Milisavljević1, Rosanda Ilić2, Ivan Bogdanović2
1Clinic for Neurosurgery, University Clinical Center of Serbia, Belgrade, Serbia.
Objective:
This research aimed to determine whether an adequate surgical approach can be chosen based on clearly defined values of anatomical landmarks (tentorial angle) and tumor size and extension.
Methods:
We conducted a retrospective analysis of patients operated on because of pineal tumors. The cohort was divided depending on the surgical approach. On preoperative magnetic resonance imaging, we measured maximal diameters, tumor volume, and tumor propagation. In the group of patients operated with the supracerebellar infratentorial approach, we also tested the correlation of tentorial angle with residual tumor. Differences among groups in resection, complications rate, and outcome were tested by the χ2 test. Finally, in both groups, the correlation of residual tumor with tumor volume, propagation, and diameters was tested using the receiver operating characteristic curve.
Results:
In the group operated with a supracerebellar approach, total resection was achieved in 78% of the patients. The critical value of cranio-caudal diameter correlated with tumor residue was 31 mm, for lateral-lateral diameter 25 mm, for the lateral extension 14 mm, and tumor volume 12 cm3. Tentorial angle did not influence the extent of the resection. In the group operated with an occipital transtentorial approach, the critical tumor volume related to tumor residue was 9 mm3, anterior-posterior diameter 29 mm, and cranio-caudal diameter 28 mm. The extent of the resection was significantly higher in the supracerebellar group.
Conclusions:
In both approaches, tumors larger than 3 cm show an increased risk of subtotal resection. Except when most tumor volume is localized above the venous system, we advocate a supracerebellar corridor as an effective approach that is not limited by tentorial angle.
Insights
Choosing the right surgical approach for pineal tumors depends on tumor size, not tentorial angle. The supracerebellar infratentorial approach offers better resection rates for most pineal tumors.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Pineal tumors are rare intracranial neoplasms.
- Surgical approach selection is crucial for optimal outcomes.
Purpose of the Study:
- To determine if surgical approach for pineal tumors can be guided by anatomical landmarks and tumor characteristics.
- To compare the efficacy of supracerebellar infratentorial and occipital transtentorial approaches.
Main Methods:
- Retrospective analysis of patients with pineal tumors.
- Measurement of tumor size, volume, and extension using MRI.
- Correlation of tentorial angle with tumor resection and residue.
Main Results:
- Supracerebellar approach achieved 78% total resection; occipital transtentorial approach had higher tumor residue.
- Critical tumor dimensions for residue: supracerebellar (31mm cranio-caudal, 25mm lateral, 14mm extension, 12cm³ volume); occipital transtentorial (29mm AP, 28mm cranio-caudal, 9mm³ volume).
- Tentorial angle did not impact resection extent; larger tumors (>3cm) increased subtotal resection risk.
Conclusions:
- Supracerebellar corridor is an effective approach for pineal tumors, independent of tentorial angle.
- Tumor size and extension are key factors in surgical approach selection.
- Advocating supracerebellar approach except when tumor is primarily above venous structures.
