Surgical Approaches to Pineal Region Tumors

Overview

Journal J Neurooncol

Publisher Springer

Date 2002 Jan 5

PMID 11767294

Citations 17

Authors

K M Little

A H Friedman

T Fukushima

Affiliations

Soon will be listed here.

Abstract

Direct surgical resection of pineal region tumors has become safer, more effective, and now plays an essential role in their management. Tissue diagnosis allows for the initiation of appropriate therapies and resection can be curative or improve the efficacy of adjuvant therapies. Several approaches have been reported. Based on our operative experience with 57 patients over a 20-year period, we conclude that the Infratentorial Supracerebellar and Parieto-Occipital Paramedian Transtentorial approaches provide excellent exposure while allowing minimally invasive, relatively low risk access to the majority of pineal region tumors. Indications, positioning, techniques, advantages, and disadvantages are discussed. A review of other approaches, pertinent historical remarks, and a discussion of the role of surgery in the contemporary management of pineal region tumors are presented.

Citing Articles

The microsurgical infratentorial supracerebellar approach for lesions of the pineal gland: feasibility, morbidity, and functional outcomes from a single-center experience.

Ahmed M, Arend R, Nordin N, Scholz M, Suchorska B, Lucaciu R Neurosurg Rev. 2025; 48(1):107.

PMID: 39883229 DOI: 10.1007/s10143-025-03259-w.

Understanding and Managing Pineal Parenchymal Tumors of Intermediate Differentiation: An In-Depth Exploration from Pathology to Adjuvant Therapies.

Bianconi A, Panico F, Lo Zito B, Do Trinh A, Cassoni P, Ricardi U J Clin Med. 2024; 13(5).

PMID: 38592098 PMC: 10931940. DOI: 10.3390/jcm13051266.

Combined cone-beam CT imaging and microsurgical dissection of cadaver specimens to study cerebral venous anatomy: a technical note.

Krogager M, Dahl R, Poulsgaard L, Fugleholm K, Sehested T, Mikkelsen R Surg Radiol Anat. 2023; 45(9):1177-1184.

PMID: 37542573 PMC: 10514096. DOI: 10.1007/s00276-023-03195-8.

Endoscopic Occipital Transtentorial Approach for Supracerebellar Lesions.

Takahara K, Miwa T, Iwama T, Toda M NMC Case Rep J. 2023; 10:185-189.

PMID: 37465249 PMC: 10351956. DOI: 10.2176/jns-nmc.2022-0363.

The surgical intervention for pineal region tumors.

Kondo A, Suzuki M, Shimizu Y, Akiyama O Childs Nerv Syst. 2023; 39(9):2341-2348.

PMID: 37436474 DOI: 10.1007/s00381-023-06071-3.

References

Nakagawa K, Aoki Y, Akanuma A, Sakata K, Karasawa K, Terahara A . Radiation therapy of intracranial germ cell tumors with radiosensitivity assessment. Radiat Med. 1992; 10(2):55-61. View

WEN H, Rhoton Jr A, De Oliveira E . Transchoroidal approach to the third ventricle: an anatomic study of the choroidal fissure and its clinical application. Neurosurgery. 1998; 42(6):1205-17; discussion 1217-9. DOI: 10.1097/00006123-199806000-00001. View

Kang J, Jeun S, Hong Y, Park C, Son B, Lee I . Experience with pineal region tumors. Childs Nerv Syst. 1998; 14(1-2):63-8. DOI: 10.1007/s003810050177. View

Fukushima T . Endoscopic biopsy of intraventricular tumors with the use of a ventriculofiberscope. Neurosurgery. 1978; 2(2):110-3. DOI: 10.1227/00006123-197803000-00006. View

Bruce J, STEIN B . Surgical management of pineal region tumors. Acta Neurochir (Wien). 1995; 134(3-4):130-5. DOI: 10.1007/BF01417679. View

Ausman J, Malik G, Dujovny M, Mann R . Three-quarter prone approach to the pineal-tentorial region. Surg Neurol. 1988; 29(4):298-306. DOI: 10.1016/0090-3019(88)90161-9. View

PLUCHINO F, Broggi G, Fornari M, Franzini A, Solero C, ALLEGRANZA A . Surgical approach to pineal tumours. Acta Neurochir (Wien). 1989; 96(1-2):26-31. DOI: 10.1007/BF01403491. View

Oi S, Matsuzawa K, Choi J, Kim D, Kang J, Cho B . Identical characteristics of the patient populations with pineal region tumors in Japan and in Korea and therapeutic modalities. Childs Nerv Syst. 1998; 14(1-2):36-40. DOI: 10.1007/s003810050172. View

Bauer B, Hellwig D . Minimally invasive endoscopic neurosurgery--a survey. Acta Neurochir Suppl. 1994; 61:1-12. DOI: 10.1007/978-3-7091-6908-7_1. View

10.

Donat J, Okazaki H, Gomez M, Reagan T, BAKER Jr H, Laws Jr E . Pineal tumors. A 53-year experience. Arch Neurol. 1978; 35(11):736-40. DOI: 10.1001/archneur.1978.00500350040008. View

11.

Wolden S, Wara W, Larson D, PRADOS M, Edwards M, Sneed P . Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys. 1995; 32(4):943-9. DOI: 10.1016/0360-3016(95)00067-9. View

12.

Ziyal I, Sekhar L, Salas E, Olan W . Combined supra/infratentorial-transsinus approach to large pineal region tumors. J Neurosurg. 1998; 88(6):1050-7. DOI: 10.3171/jns.1998.88.6.1050. View

13.

Fukushima T, Ishijima B, Hirakawa K, Nakamura N, Sano K . Ventriculofiberscope: a new technique for endoscopic diagnosis and operation. Technical note. J Neurosurg. 1973; 38(2):251-6. DOI: 10.3171/jns.1973.38.2.0251. View

14.

DANDY W . EXTIRPATION OF THE PINEAL BODY. J Exp Med. 2009; 22(2):237-46. PMC: 2125310. DOI: 10.1084/jem.22.2.237. View

15.

Nazzaro J, Shults W, Neuwelt E . Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg. 1992; 76(5):746-51. DOI: 10.3171/jns.1992.76.5.0746. View

16.

Oi S, Matsumoto S . Controversy pertaining to therapeutic modalities for tumors of the pineal region: a worldwide survey of different patient populations. Childs Nerv Syst. 1992; 8(6):332-6. DOI: 10.1007/BF00296564. View

17.

Sekhar L, Goel A . Combined supratentorial and infratentorial approach to large pineal-region meningioma. Surg Neurol. 1992; 37(3):197-201. DOI: 10.1016/0090-3019(92)90230-k. View

18.

Fukui M, Matsushima T, Fujii K, Nishio S, Takeshita I, Tashima T . Pineal and third ventricle tumours in the CT and MR eras. Acta Neurochir Suppl (Wien). 1991; 53:127-36. DOI: 10.1007/978-3-7091-9183-5_22. View

19.

Kobayashi S, Sugita K, Tanaka Y, Kyoshima K . Infratentorial approach to the pineal region in the prone position: Concorde position. Technical note. J Neurosurg. 1983; 58(1):141-3. DOI: 10.3171/jns.1983.58.1.0141. View

20.

Berger M, Baumeister B, Geyer J, MILSTEIN J, Kanev P, Leroux P . The risks of metastases from shunting in children with primary central nervous system tumors. J Neurosurg. 1991; 74(6):872-7. DOI: 10.3171/jns.1991.74.6.0872. View