Keyhole Suboccipital Endoscopic-Assisted Microsurgical Approach for Management of Pineal Region Tumors

Introduction: Tumors of the pineal region constitute more than 1% of brain tumors. The deep location of the pineal region and close vicinity to vital neural and vascular structures make it challenging target for neurosurgeons. Many surgical approaches were described for management of these tumors; the infratentorial supracerebellar approach is the most used approach. Minimally invasive approaches and the use of endoscopic-assisted microsurgical technique improve the outcome in most of transcranial surgery including the pineal region tumors.

Patients and Methods: Eighteen patients with pineal region tumors were operated in the past 8 years using this approach; 10 males and 8 females, age ranged from 16 to 48 years. Most common presenting complaints were headache and gaze disturbances.

Results: Total excision was achieved in 12 patients. Three patients developed transient post-op. One patient with Parinaud’s syndrome needed VP shunt postoperatively.

Conclusion: The tumors of the pineal region represent a significant challenge for surgical management due to deep location and critical structures around it. Minimally invasive approach and the use of endoscopic-assisted microsurgery make surgical excision of tumors of the pineal region safe and effective in comparison to standard microsurgical technique with less approach-related morbidity.

No conflict of interest has been declared by the author(s).