gms | German Medical Science

Objective: Tumours of the pineal region are rare. Surgery is considered to be associated with high morbidity and the ideal surgical management is quite variable. Our aim was to evaluate the presentation, entity and operative outcome of adults with tumours of the pineal region in a single institution.

Method: Adult patients (older 18 years) with tumours of the pineal region admitted to our department between 1980 until 2012 were identified. Their data were retrospectively reviewed with respect to presentation, histology, treatment, complications, hydrocephalus and route of operation.

Results: 115 adult patients were treated at our institution between 1980 and 2012. Median age at diagnosis was 37.7 years (range 18-84 years). There were 58 male and 57 female patients. Major symptoms were headache (69.6%), symptoms of increased intracranial pressure (46.1%), and gaze palsies (18.3%.) 34 (29.6%) patients presented with hydrocephalus requiring urgent treatment. In 76 (66.1%) patients conservative diagnostics/treatment was performed; 6 (5.2%) patients received a biopsy.

33 (28.7%) patients were operated by the infratentorial, supracerebellar approach, facilitating gross total resection in 27 (82%) patients. Nevertheless, 15 (45.5%) of them needed ventricular shunting. There was no fatal operative outcome. Perioperative morbidity was minimal with 2 (6%) postoperative bleedings, 1 (3%) deep vein thrombosis, 2 (6%) pneumocephalus, and 1 (3%) CSF fistula. Additional postoperative ataxia and gaze palsies were present in 3 (9.1%) and 6 (18.2%) patients, respectively. In 6-months-follow-up there was 1 (3%) patient with persistent ataxia and 3 (9.1%) patients with persistent gaze palsies. Histology in the operated group (biopsy and infratentorial, supracerebellar approach) revealed 3 (7.7%) pineal cysts, 7 (17.9%) pineocytomas (WHO °I), 9 (23.1%) pineocytomas of intermediate differentiation (WHO °II/°III), 8 (20.5%) pineoblastomas, 6 (15.4%) germinomas, 1 (2.5%) teratoma, 3 (7.9%) meningeomas, 1 (2.5%) lipoma, and 1 (2.5%) papillary tumour of the pinealis.

Conclusions: Increased intracranial pressure (46.1%) and gaze palsies (18.3%) are the major symptoms of pineal region tumours. The infratentorial, supracerebellar approach is safe with minimal perioperative morbidity/mortality and ensures maximal tumour resection (82%). Shunting remains necessary in 45.5 % of these patients.