Experience with pineal region tumours in childhood
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Pineal region tumors in children are operable and treatable. Aggressive surgical management has significantly reduced operative mortality, emphasizing the need for histologic confirmation in diagnosis and treatment planning.
Area of Science:
- Pediatric Neurosurgery
- Pediatric Oncology
- Tumor Histopathology
Background:
- Pineal region tumors represent a significant challenge in pediatric neurosurgery.
- Historically, management strategies have evolved, impacting patient outcomes.
Purpose of the Study:
- To analyze the management and outcomes of pediatric pineal region tumors.
- To evaluate the effectiveness of an aggressive surgical approach and its impact on operative mortality.
Main Methods:
- Retrospective review of 61 children with pineal region tumors managed between 1950-1982.
- Analysis of surgical interventions, histologic diagnoses, and operative mortality rates.
- Comparison of outcomes before and after the adoption of an aggressive surgical strategy in 1967.
Main Results:
- Germ cell tumors were the most common, though germinomas constituted only one-third of cases.
- An aggressive surgical approach was adopted for 41 patients since 1967, with 34 undergoing direct surgery.
- Operative mortality for pineal tumor surgery decreased significantly, with a 4.3% rate from 1975-1982 and no deaths since 1977.
Conclusions:
- Pineal region tumors are operable, with benign lesions recommended for removal.
- Histologic confirmation is crucial for rational management of malignant pineal tumors.
- An aggressive surgical strategy has proven effective in reducing mortality for these pediatric tumors.
Abstract:
Sixty-one children with pineal region tumours were managed at the Hospital for Sick Children during the period 1950-1982. Histologic verification of these tumours was possible in forty-six children. Although germ cell tumours were the commonest form, germinomas only made up one third of the pineal region tumours. Since 1967, an aggressive approach has been adopted in the management of pineal region tumours at the Hospital for Sick Children with thirty-four patients having direct surgery on their pineal region mass out of a total of forty-one patients with such tumours. The operative mortality for pineal tumour surgery has steadily fallen so that the operative mortality between 1975 and 1982 was 4.3% and there have been no operative deaths since 1977 among the thirteen patients with pineal region tumours who have been operatively treated. Pineal tumours are operable lesions which should be removed if they are benign. Histologic confirmation should be obtained if they are malignant in order to provide for rational management of these lesions.