Article
Surgical treatment of pineal region lesions in 69 patients
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Authors
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Stepan Fedorko
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
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Andreas W. Unterberg
- Universitätsklinikum Heidelberg, Neurochirurgische Klinik, Heidelberg, Deutschland
| Published: | June 18, 2018 |
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Outline
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Objective: Tumors of the pineal region are rare and a heterogeneous group of lesions. Currently there is lack of consensus concerning the optimal treatment of these lesions. Treatment often encompasses multimodal therapy consisting of neurosurgical intervention and oncological therapy. 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 experience with the surgical treatment of pineal region lesions (PRL) in 69 patients.
Methods: We prospectively and retrospectively analyzed all patients who underwent surgical treatment of PRL at our institution from 2005 to 2017. A total of 69 patients (51 female and 18 male) with a mean age of 39±19 years were identified. Mean follow-up was 30±27 months. In 67 patients removal of lesion was performed through a supracerebellar infratentorial approach. Resection of the lesions were performed in the semisitting position (n=64) and in the concorde position (n=3, all children). Tumor biopsy and ETV only was performed in 2 patients.
Results: In the majority of cases symptoms were due to increased intracranial pressure and Parinaud’s syndrome. Obstructive hydrocephalus (OH) was preoperatively diagnosed in 64% patients. Gross total resection of the tumor was achieved in 64%. Complete extirpation of the cyst was achieved in 72%. Surgically mortality was 0%. Permanent major morbidity occurred in 1,5% and minor morbidity in 9,0% of patients. No paradoxical air embolism occurred during the operations. We noticed a beneficial effect of surgery in several domains of health-related quality of life (HRQOL) and disability (Wilcoxon test, p<0,0001) as measured by EORTC QLQ-C30 and modified Rankin score respectively. Furthermore we observed a statistically significant reduction of the necessity for a permanent shunt diversion after GTR compared to STR (Chi-square test, p=0,038) in patients harboring OH prior the surgery.
Conclusion: A positive effect of the surgical removal of PRL on HRQOL, disability and necessity for a permanent shunt diversion was found. Rates of surgical mortality and morbidity are low. The supracerebellar infratentorial approach is safe and suitable for the majority of the PRLs. Thus, radical surgical resection should be considered in most cases of PRLs.
