gms | German Medical Science

Objective: Tumours of the pineal region are rare lesions that may cause obstructive hydrocephalus or visual disturbance. Neurosurgical treatment is challenging due to the central location of the pineal region and its immediate vicinity to venous structures and highly eloquent brain regions. Here we report our experiences with the surgical treatment of pineal region tumours in 42 patients.

Method: We retrospectively analysed all patients who underwent surgical treatment of pineal region tumours at our institution from 2005 to 2013. A total of 42 patients (female: 29, male: 13) with a mean age of 35±15 years were identified. In all patients, surgery was performed through a supracerebellar infratentorial approach. Procedures were performed in the semisitting position (n=39) and in the concorde position (n=3, all children).

Results: In the majority of cases, symptoms were due to increased intracranial pressure and Parinaud’s syndrome with 30 patients having evidence of hydrocephalus on cerebral imaging studies. Complete tumour resection was achieved in 71% of cases (n=22) and in 29% of cases (n=9) the tumour was partially resected. Arachnoid cysts and pineal cysts were either fenestrated or resected. The surgical mortality was 0% and the neurological status improved or remained unchanged in 41 patients (98%). Ten patients (24%) had transient neurological deficits which completely resolved during the further course. One patient (2%) developed permanent limb paralysis and a decreased level of consciousness postoperatively. Five patients died after initial improvement because of progressive malignant disease. Histopathological examination of resected tissue revealed pilocytic astrocytoma WHO °I (n=9), pineal cyst (n=8), meningioma WHO °I (n=4), pineal tumour WHO °II (n=4), metastasis (n=3), arachnoid cyst (n=3), hemangioma WHO °II (n=2), teratoid-rhabdoid tumour WHO °IV (n=2), germinoma (n=1), anaplastic ependymoma WHO °III (n=1), glioblastoma WHO °IV (n=1), hemangiopericytoma WHO °II (n=1) and ependymoma WHO °II (n=1). In two patients, haemorrhagic pineal tissue was identified.

Conclusions: The supracerebellar infratentorial approach is very safe for the surgical treatment of pineal region lesions. Rates of surgical mortality and morbidity are low and in light of the broad spectrum of tumour pathologies, radical surgical therapy should be considered in patients presenting with this rare entity.