gms | German Medical Science

Objective: In the literature, surgery of pineal region tumours still bears a high risk for morbidity and mortality. The indication for surgical removal of such lesions seems particularly problematic in patients with mild symptoms and relatively small lesions that are considered to be of low proliferative activity. In this retrospective study both the clinical outcome, as well as histopathological results were evaluated to elaborate new criteria for the decision making in the management of symptomatic pineal tumours.

Methods: 28 patients with symptomatic pineal region tumours were treated microsurgically between 8/1997 and 7/2006 at our institution. Surgical specimens were examined histopathologically, particularly with regard to the proliferative activity (MIB-1 index) of these lesions. All but one patient were followed up clinically and radiologically for a mean time of 23.7 months postoperatively. In addition, patients with benign lesions of the pineal gland were evaluated with a quality of life questionnaire (EORTC QLQ C30) at a mean of 22.7 months after the operation.

Results: Preoperatively, 93% (26/28) of the patients showed signs and symptoms of hydrocephalus, which could be improve in 88% (22/26) of cases. A complete resection of the lesion could be achieved in 86% (24/28) of cases without mortality or severe permanent morbidity. Histological examination of tumour specimens revealed five pineal cysts, eleven pineocytomas, one pineoblastoma, six low-grade gliomas, two malignant gliomas, one metastasis, one anaplastic plexus papilloma and one ependymoma. All specimens showed proliferative activity. However, the MIB-1 index varied widely between the lesions. 19 of 21 patients with benign lesions of the pineal gland answered the quality of life questionnaire. Seventeen of these 19 individuals stated that their overall health status had improved from a mean score of 41% to 81% after the operation whereas it stayed unchanged in the remaining two patients.

Conclusions: Well defined tumours of the pineal region can be resected safely leading to an objective improvement of symptoms and a subjective gain in health status in most cases. A complete resection can be achieved with very low morbidity and no mortality. The histopathological analysis of our cases revealed that the distinction between purely expanding and growing lesions is not trivial, even using proliferation indicators. Thus, a new appraisal of both indication for surgery and histopathological evaluation seems to be necessary.