gms | German Medical Science

Objective: Pineal region tumors are characterized by a broad variability of size, existing hydrocephalus as well as histopathological entity. Clinical presentation is distinguished between late onset with approximately permanent ailment mainly indicating treatment and early onset with periodically occurrance of symptoms found in most patients. Aim of this analysis is to show possible correlations of clinical presentation to above mentioned tumor features.

Method: Patients with pineal region tumor treated at our institution from 2000 to 2013 were retrospectively analyzed with respect to multiple patient characteristics including histological diagnosis, early and late onset symptoms (EOS, LOS), postoperative outcome, tumor size and extent of hydrocephalus (measured by FOHR).

Results: 59 cases were included, median age was 15.6 yrs (range: 0.4–68.5 yrs). Most lesions were benign pineal cysts (49%), benign tumors 32% and malignant tumors 19%. Median tumor volume in cysts was 1.18ccm, in benign tumors 2.58ccm, in malignant tumors 5.2 ccm (cyst vs. tumor p<0.0001, malignant vs. benign p=0.51), extent of hydrocephalus (FOHR) in cysts was 0.37, in benign tumors 0.46, in malignant tumors 0.42 (cyst vs. tumor p<0.0001, malignant vs. benign p=0.52). Median time of LOS and EOS to treatment was 0.25 and 6 months, respectively. LOS occurred in 58% of cysts (median time to treatment: 2.1 months), 53% of benign tumors (1.2 months), 82% of malignant tumors (0.6 months), EOS occurred in 83% (12.8 months) of cysts, 79% (4.3 months) of benign tumors and 64% (7 months) of malignant tumors. FOHR vs. tumor volume, LOS show positive correlation, respectively. Tumor volume vs. EOS, LOS shows negative correlation, respectively. FOHR vs. EOS shows no correlation. Postoperative improvement of complaints occurred in 63% (cysts 86%, benign tumors 45%, malignant tumor 55%).

Conclusions: Occurrence and duration of late onset symptoms depends on tumor volume and extent of hydrocephalus in contrast to early onset symptoms which seem not to be related to extent of hydrocephalus. Histopathological diagnosis shows no direct influence on clinical presentation.