gms | German Medical Science

Tumors of the pineal region represent a major neurosurgical problem and their optimal treatment is controversial. Direct microsurgical approach is frequently indicated, but it involves many operative risks to the deep location and the presence of important vascular structures. On the other hand, the endoscopic surgery may play an important role in most patients with pineal region tumors, because it allows us to treat symptomatic hydrocephalus and to safety perform tumor biopsy under direct vision.

We report our experience with 19 patients with pineal region tumors treated by endoscopic technique. The procedure included in all cases third ventriculostomy for the treatment of hydrocephalus, CSF sample for cytology and tumor markers, and tumor biopsy for histological diagnosis. Endoscopic biopsies showed a pineocytoma in three cases, a pineoblastoma in one, a germinoma in five, a low-grade astrocytoma in three, a subependymoma in two cases and an atypical meningioma in one case. In three cases biopsy didn't give any histological founds. Only in one patient biopsy was not performed. The endoscopic procedure may allow us to select cases requiring a microsurgical approach (medium-sized or large non-germ-cell tumors) from cases to be treated only by irradiation and chemotherapy (germinomas and other malignant germ cell tumors). Then, in some patients with pineal region tumors the endoscopic procedure remains the only surgical treatment. When a direct microsurgical approach is indicated, it may be performed safely, in a non-emergency situation, and after treatment of the hydrocephalus by endoscopic third ventriculostomy.