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Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study

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Abstract

Pineal region tumors are extremely deep-seated and surgically challenging. The exposure and visualization obtained by microscopic surgery are relatively limiting. The application of high-definition endoscopes has recently provided neurosurgeons with a much more magnified and clearer view of the anatomy in the pineal region. The present study was performed to compare endoscopic-assisted surgery (ES) with microsurgery (MS) for pineal region tumors. We retrospectively analyzed patients admitted to our hospital for treatment of pineal region tumors from January 2016 to June 2019. All patients consented to undergo tumor resection with ES or MS. We compared the extent of resection, postoperative rate of hydrocephalus, complications, and outcomes between the two groups to estimate the safety and efficacy of ES. In total, 41 patients with pineal region tumors were divided into 2 groups: the ES group (n = 20) and MS group (n = 21). The rate of gross total resection was significantly higher in the ES than MS group (90.0% vs. 57.1%, p = 0.04). The rate of postoperative hydrocephalus was significantly lower in the ES than MS group (11.8% vs. 52.9%, p = 0.03). No significant differences were found in complications or the Karnofsky Performance Score between the two groups. ES can be used to safely and effectively achieve complete resection of pineal region tumors. In patients with obstructive hydrocephalus, ES provides a new way to directly open the aqueduct for cerebrospinal fluid recovery following tumor resection.

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References

  1. Inoue A, Ohnishi T, Kohno S, Ohue S, Iwata S, Matsumoto S, Nishikawa M, Ozaki S, Mizuno Y, Kitazawa R, Kunieda T (2018) Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment. Neurosurg Rev 41:197–206. https://doi.org/10.1007/s10143-017-0835-y

    Article  PubMed  Google Scholar 

  2. Sonabend AM, Bowden S, Bruce JN (2016) Microsurgical resection of pineal region tumors. J Neuro-Oncol 130:351–366. https://doi.org/10.1007/s11060-016-2138-5

    Article  CAS  Google Scholar 

  3. Lo AC, Hodgson D, Dang J, Tyldesley S, Bouffet E, Bartels U, Cheng S, Hukin J, Bedard PL, Goddard K, Laperriere N (2019) Intracranial germ cell tumors in adolescents and young adults: a 40-year multi-institutional review of outcomes. Int J Radiat Oncol Biol Phys. https://doi.org/10.1016/j.ijrobp.2019.10.020

  4. Liu JK, Cohen MA (2016) Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances. Neurosurg Focus 40 Video Suppl 1:2016 2011 FocusVid 15453. https://doi.org/10.3171/2016.1.FocusVid.15453

    Article  Google Scholar 

  5. Sinha S, Culpin E, McMullan J (2018) Extended endoscopic supracerebellar infratentorial (EESI) approach for a complex pineal region tumour-a technical note. Childs Nerv Syst 34:1397–1399. https://doi.org/10.1007/s00381-018-3797-7

    Article  PubMed  PubMed Central  Google Scholar 

  6. Broggi M, Darbar A, Teo C (2010) The value of endoscopy in the total resection of pineocytomas. Neurosurgery 67:ons159–ons165. https://doi.org/10.1227/01.NEU.0000383136.40033.2D

    Article  PubMed  Google Scholar 

  7. Shahinian H, Ra Y (2013) Fully endoscopic resection of pineal region tumors. J Neurol Surg B Skull Base 74:114–117. https://doi.org/10.1055/s-0033-1338165

    Article  PubMed  PubMed Central  Google Scholar 

  8. Abecassis IJ, Hanak B, Barber J, Mortazavi M, Ellenbogen RG (2017) A single-institution experience with pineal region tumors: 50 tumors over 1 decade. Oper Neurosurg (Hagerstown) 13:566–575. https://doi.org/10.1093/ons/opx038

    Article  Google Scholar 

  9. Samadian M, Maloumeh EN, Shiravand S, Ebrahimzadeh K, Sharifi G, Mousavinejad A, Rezaei O (2019) Pineal region tumors: long-term results of endoscopic third ventriculostomy and concurrent tumor biopsy with a single entry approach in a series of 64 cases. Clin Neurol Neurosurg 184:105418. https://doi.org/10.1016/j.clineuro.2019.105418

    Article  PubMed  Google Scholar 

  10. Hernesniemi J, Romani R, Albayrak BS, Lehto H, Dashti R, Ramsey C 3rd, Karatas A, Cardia A, Navratil O, Piippo A, Fujiki M, Toninelli S, Niemela M (2008) Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 70:576–583. https://doi.org/10.1016/j.surneu.2008.07.019

    Article  PubMed  Google Scholar 

  11. Hoffman HJ, Yoshida M, Becker LE, Hendrick EB, Humphreys RP (1994) Pineal region tumors in childhood. Experience at the Hospital for Sick Children. 1983. Pediatr Neurosurg 21:91–103; discussion 104. https://doi.org/10.1159/000120821

    Article  CAS  PubMed  Google Scholar 

  12. Qi S, Fan J, Zhang XA, Zhang H, Qiu B, Fang L (2014) Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir 156:2253–2262. https://doi.org/10.1007/s00701-014-2224-4

    Article  PubMed  Google Scholar 

  13. Tate M, Sughrue ME, Rutkowski MJ, Kane AJ, Aranda D, McClinton L, McClinton L, Barani IJ, Parsa AT (2012) The long-term postsurgical prognosis of patients with pineoblastoma. Cancer 118:173–179. https://doi.org/10.1002/cncr.26300

    Article  PubMed  Google Scholar 

  14. Zaidi HA, Elhadi AM, Lei T, Preul MC, Little AS, Nakaji P (2015) Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches. World Neurosurg 84:257–266. https://doi.org/10.1016/j.wneu.2015.03.009

    Article  PubMed  Google Scholar 

  15. Konovalov AN, Pitskhelauri DI (2003) Principles of treatment of the pineal region tumors. Surg Neurol 59:250–268. https://doi.org/10.1016/s0090-3019(03)00080-6

    Article  PubMed  Google Scholar 

  16. Luo SQ, Li DZ, Zhang MZ, Wang ZC (1989) Occipital transtentorial approach for removal of pineal region tumors: report of 64 consecutive cases. Surg Neurol 32:36–39. https://doi.org/10.1016/0090-3019(89)90032-3

    Article  CAS  PubMed  Google Scholar 

  17. Mottolese C, Szathmari A, Ricci-Franchi AC, Beuriat PA, Grassiot B (2015) The sub-occipital transtentorial approach revisited base on our own experience. Neurochirurgie 61:168–175. https://doi.org/10.1016/j.neuchi.2013.12.005

    Article  CAS  PubMed  Google Scholar 

  18. Sajko T, Kudelic N, Lupret V, Lupret V Jr, Nola IA (2009) Treatment of pineal region lesions: our experience in 39 patients. Coll Antropol 33:1259–1263

    PubMed  Google Scholar 

  19. Bruce JN, Ogden AT (2004) Surgical strategies for treating patients with pineal region tumors. J Neuro-Oncol 69:221–236. https://doi.org/10.1023/b:neon.0000041885.09226.2d

    Article  Google Scholar 

  20. Rangel-Castilla L, Hwang SW, Jea A, Torres-Corzo J (2012) Efficacy and safety of endoscopic transventricular lamina terminalis fenestration for hydrocephalus. Neurosurgery 71:464–473; discussion 473. https://doi.org/10.1227/NEU.0b013e31825b1e8d

    Article  PubMed  Google Scholar 

  21. Pitskhelauri DI, Konovalov AN, Kornienko VN, Serova NK, Arutiunov NV, Kopachev DN (2009) Intraoperative direct third ventriculostomy and aqueductal stenting in deep-seated midline brain tumor surgery. Neurosurgery 64:256–266; discussion 266-257. https://doi.org/10.1227/01.NEU.0000338260.05545.84

    Article  PubMed  Google Scholar 

  22. Zhang Z, Wang H, Cheng H, Fan Y, Hang C, Sun K, Zhu L (2013) Management of hydrocephalus secondary to pineal region tumors. Clin Neurol Neurosurg 115:1809–1813. https://doi.org/10.1016/j.clineuro.2013.05.009

    Article  PubMed  Google Scholar 

  23. Lutterbach J, Fauchon F, Schild SE, Chang SM, Pagenstecher A, Volk B, Ostertag C, Momm F, Jouvet A (2002) Malignant pineal parenchymal tumors in adult patients: patterns of care and prognostic factors. Neurosurgery 51:44–55; discussion 55-46. https://doi.org/10.1097/00006123-200207000-00006

    Article  PubMed  Google Scholar 

  24. Santos de Oliveira R, Barros Juca CE, Valera ET, Machado HR (2008) Hydrocephalus in posterior fossa tumors in children. Are there factors that determine a need for permanent cerebrospinal fluid diversion? Childs Nerv Syst 24:1397–1403. https://doi.org/10.1007/s00381-008-0649-x

    Article  PubMed  Google Scholar 

  25. Steiger HJ, Gotz C, Schmid-Elsaesser R, Stummer W (2000) Thalamic astrocytomas: surgical anatomy and results of a pilot series using maximum microsurgical removal. Acta Neurochir 142:1327–1336; discussion 1336-1327. https://doi.org/10.1007/s007010070001

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Can Xin and Zhongwei Xiong contributed equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan University, 169 Donghu Rd, Wuhan, 430071, China

    Can Xin, Zhongwei Xiong, Seyedali Zolfaghari, Yuankun Cai, Zhiyang Ma, Tingbao Zhang, Jianjian Zhang, Zhengwei Li, Kui Liu & Jincao Chen

  2. Department of Allergy, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China

    Xixi Yan

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  1. Can Xin
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Correspondence to Jincao Chen.

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The current study was approved by the ethical committee of our hospital.

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Can Xin and Zhongwei Xiong are co-first authors

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Xin, C., Xiong, Z., Yan, X. et al. Endoscopic-assisted surgery versus microsurgery for pineal region tumors: a single-center retrospective study. Neurosurg Rev 44, 1017–1022 (2021). https://doi.org/10.1007/s10143-020-01283-6

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  • DOI: https://doi.org/10.1007/s10143-020-01283-6

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