Endoscopic Approach for the Treatment of Pineal Region Tumors

Abstract

Tumors of the pineal region account for 3 to 8% of the tumors involving the central nervous system. The most common are germ cell tumors (39%). Less common examples include teratomas, primitive neuroectodermic tumors, astrocytomas, and choriocarcinomas. Clinical presentation in pediatric patients is in direct relation to the anatomical structures surrounding the pineal region and to the associated hydrocephalus that is present in almost 90% of cases. The diagnosis of a tumor in the pineal region is based on radiological findings and the presence of tumor markers such as α-fetoprotein and human chorionic gonadotrophic hormone subfraction β. Neuroendoscopy is considered to be one of the minimally invasive techniques useful for the management of such patients. This minimally invasive approach to pineal region tumors allows the treatment of hydrocephalus in a safe and effective way, avoiding the complications derived from other procedures such as external ventricular drainage or shunt surgery.

Keywords

hydrocephalus - obstructive hydrocephalus - neuroendoscopy - brain neoplasms - primary - germ cell tumors

• References

• 1 Abay II EO, Laws Jr ER, Grado GL , et al. Pineal tumors in children and adolescents. Treatment by CSF shunting and radiotherapy. J Neurosurg 1981; 55: 889-895
• 2 Matsumoto K, Imaoka T, Tomita S, Ohmoto T. Pineocytoma with massive intratumoral hemorrhage after ventriculoperitoneal shunt—case report. Neurol Med Chir (Tokyo) 1997; 37: 911-915
• 3 Robinson S, Cohen AR. The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol 1997; 48: 360-365 , discussion 365–367
• 4 Gaab MR, Schroeder HW. Neuroendoscopic approach to intraventricular lesions. J Neurosurg 1998; 88: 496-505
• 5 Gangemi M, Maiuri F, Colella G, Buonamassa S. Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg 2001; 44: 70-73
• 6 Yamini B, Refai D, Rubim CM, Frim DM. Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 2004; 100 (5 Suppl) 437-441
• 7 Bruce JN, Ogden AT. Surgical strategies for treating patients with pineal region tumors. J Neurooncol 2004; 69: 221-236
• 8 Vinas FC, Dujovny N, Dujovny M. Microanatomical basis for the third ventriculostomy. Minim Invasive Neurosurg 1996; 39: 116-121
• 9 Oka K, Kin Y, Go Y , et al. Neuroendoscopic approach to tectal tumors: a consecutive series. J Neurosurg 1999; 91: 964-970
• 10 Oi S, Shibata M, Tominaga J , et al; OI S. Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study. J Neurosurg 2000; 93: 245-253
• 11 Veto F, Horváth Z, Dóczi T. Biportal endoscopic management of third ventricle tumors in patients with occlusive hydrocephalus: technical note. Neurosurgery 1997; 40: 871-875 , discussion 875–877
• 12 Ferrer E, Santamarta D, Garcia-Fructuoso G, Caral L, Rumià J. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 1997; 139: 12-20 , discussion 20–21
• 13 Turtz AR, Hughes WB, Goldman HW. Endoscopic treatment of a symptomatic pineal cyst: technical case report. Neurosurgery 1995; 37: 1013-1014 , discussion 1014–1015
• 14 Oi S, Hidaka M, Honda Y , et al. Neuroendoscopic surgery for specific forms of hydrocephalus. Childs Nerv Syst 1999; 15: 56-68
• 15 Santhanam R, Balasubramaniam A, Chandramouli BA. Fatal intratumoral hemorrhage in posterior fossa tumors following ventriculoperitoneal shunt. J Clin Neurosci 2009; 16: 135-137
• 16 Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphreys RP. Pineal region tumors in childhood. Experience at the Hospital for Sick Children. 1983. Pediatr Neurosurg 1994; 21: 91-103 , discussion 104
• 17 Cipri S, Gangemi A, Cafarelli F , et al. Neuroendoscopic management of hydrocephalus secondary to midline and pineal lesions. J Neurosurg Sci 2005; 49: 97-106