Summary
Tumours of the pineal region and posterior part of the third ventricle are rare in European and American series (0.5 to 1% of space-occupying lesions). Personal experience is usually limited and thus cooperative studies or critical reviews of reported cases are necessary to establish therapeutic criteria.
We have studied 50 cases from our own material of more than 5,000 brain tumours and intracranial space-occupying lesions operated on during the last 30 years. Another 6 verified cases from Dr. F. Isamat, and more than 200 verified tumours from the literature are added. Histological distribution shows that 24% of the tumours in this locality are benign.
The different surgical techniques for reaching the pineal region are reviewed. The results of palliative operations, or partial removals together with radiotherapy, and total removals are presented in 200 verified cases (Table 1), as well as the results obtained by the different surgical approaches (Table 2).
Finally, some conclusions are reached regarding the surgical management of these tumours. More than two thirds are radiosensitive, and in about 50 to 70% good results may be obtained with palliative operations and radiotherapy. The remainder of the pineal tumours (about 20%) should be treated by a direct surgical approach. Recent technical improvements and the use of the surgical microscope have reduced the mortality of pineal surgery and allow verification of the histological nature of the tumour in order to establish more rational treatment.
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References
Araki, C., Matsumoto, S., Statistical reevaluation of pinealoma and related tumors in Japan. J. Neurosurg.30 (1969), 146–149.
Bradfield, J. S., Perez, C. A., Pineal tumors and ectopic pinealomas. Radiology103 (1972), 399–406.
Brunner, C., Cited by Rorschach, H.. (1919).
Carrier, H., Gutelle, A., Tommasi, M.,et al., Tumeur mélanique de la région pineale. J. Med. Lyon.52/1201 (1971), 105–115.
Cole, H., Tumours in the region of the pineal. Clinical Radiology22 (1971), 110–117.
Cummins, F. M., Taveras, J. M., Schlesinger, E. B., Treatment of gliomas of the third ventricle and pinealomas: With special reference to the value of radiotherapy. Neurology (Minneap.)10 (1960), 1031–1036.
Cushing, H., Intracranial tumors: Notes upon a series of two thousand verified cases with surgical mortality pertaining thereto. Springfield, Ill.: Ch. C Thomas (1932), 62–65.
Dandy, W. E., An operation for the removal of pineal tumors. Surg. Gynec. Obstet.33 (1921), 113–119.
Davis, R. L., Cited by Smith, R. A., and Estridge, M. N.. (1974).
De Girolami, U., Schmidek, H., Clinicopathological study of 53 tumors of the pineal region. J. Neurosurg.39 (1973), 455–462.
Ehni, G., Pineal teratoma. Report of case. J. Neurosurg.3 (1947), 86–94.
El Mahdi, A. M., Philips, E., Lott, S., The role of radiation therapy in pinealoma. Radiology103 (1972), 407–412.
Ennuyer, A., Guiot, G., Chehuillaume, J., Guenot, J., A propos de la radiotherapie des tumeurs de la region épiphysaire. Semaine Hôp. Paris32 (1956).
Foerster, O., Cited by Krause, F.. (1926).
Fowler, F. D., Alexander, E., Jr., Davis, C. H., Jr., Pinealoma with metastases in the central nervous system. A rationale of treatment. J. Neurosurg.13 (1956), 271–288.
Grant, F. C., A study of the results of surgical treatment in 2,326 consecutive patients with brain tumor. J. Neurosurg.13 (1956), 479–488.
Glasauer, F. E., An operative approach to pineal tumors. Acta Neurochir.22 (1970), 177–180.
Haldeman, K. O., Tumors of the pineal gland. Arch. Neurol. Psychiat.18 (1927), 724–754.
Heppner, F., Über Meningiome des 3. Ventrikels. Acta Neurochir.4 (1954), 55–67.
Hide, T. A. H., Pineal region tumors. J. Neurol. Neurosurg. Psychiat.32 (1969), (abstract), 68.
Horrax, G., Treatment of tumors of the pineal body: experience in a series of twenty-two cases. Arch. Neurol. Psychiat.64 (1950), 227–242.
Horsley, V., Discussion. Proc. Roy. Soc. Med.3 (PT 2), (1910), 77.
Huckman, M. S., Davis, D. O., Coxe, W. S., Arachnoid cyst of the quadrigeminal plate. J. Neurosurg.32 (1970), 367–370.
James, W., Teratoma in region of pineal body-Report of a case. J. Neurosurg.14 (1957), 235–241.
Jamieson, K. G., Excision of pineal tumors. J. Neurosurg.35 (1971), 550–553.
Kahn, E. A., Tumors involving the third ventricle. Clinical Neurosurg. VII, 78–99. Baltimore: Williams and Wilkins. 1958.
Katsura, S., Suzuki, J., Wada, T. A., Statistical study of brain tumors in the neurosurgical clinics in Japan. J. Neurosurg.16 (1959), 570–588.
Kirsch, W. M., Stears, J. C., Radiographic identification and surgical excision of an epidermoid tumor of the pineal gland. J. Neurosurg.33 (1970), 708–713.
Krause, F., Operative Freilegung der Vierhügel, nebst Beobachtungen über Hirndruck und Dekompression. Zbl. Chir.53 (1926), 2812–2819.
Kunicki, A., Operative experiences in 8 cases of pineal tumor. J. Neurosurg.17 (1960), 815–823.
Lazar, M. L., Clark, K., Direct surgical management of masses in the region of the vein of Galen. Surg. Neurol.2 (1974), 17–21.
Lenshoek, C. H., Deux cas de tumeurs du troisième ventricule opérés en 1937. Neurochirurgie12 (1966), 619–620.
Maier, J. G., De Jong, D., Pineal body tumors. Amer. J. Roentgen.99 (1967), 826–832.
Obrador, S., El problema terapeutico de los tumores del tercer ventriculo. Rev. Clin. Esp.86 (1962), 167–171.
Olivecrona, H., The surgical treatment on intracranial tumors. Handbuch der Neurochirurgie, IV. Band, IV. Teil, S. 1–301. Berlin-Heidelberg-New York: Springer. 1967.
Olson, J. R., Abell, M. R., Haemangiopericytoma of the pineal body. J. Neurol. Neurosurg. Psychiat.32 (1969), 445–449.
Ouyang, R., Rozdilsky, B., Metastasis of carcinoma to pineal body. Report of two cases. Arch. Neurol. (Chic.)15/4 (1966), 399–403.
Paillas, J. E., Sedan, R., Combalbert, A., Payan, H., Salamon, G., Tératome parapinéal chez un enfant. Guérison opératoire. Neurochirurgie12 (1966), 549–554.
Pecker, J., Ferrand, B., Javalet, A., Tumeurs du troisième ventricule. Neurochirurgie12 (1966), 1–136.
Pia, H. W., Klinik, Differentialdiagnose und Behandlung der Vierhügelgeschwülste. Dtsch. Z. Nervenheilk. Vol.172 (1954), 12.
Poppen, J. L., The right occipital approach to a pinealoma. J. Neurosurg.25 (1966), 706–710.
—, Marino, R., Jr., Pinealomas and tumors of the posterior portion of the third ventricle. J. Neurosurg.28 (1968), 357–364.
Rand, R. W., Lemmen, U. J., Tumors of the posterior portion of the third ventricle. J. Neurosurg.10 (1953), 1–18.
Ringertz, N., Nordenstan, H., Flyger, G., Tumors of the pineal region. J. Neuropath. Exp. Neurol.13 (1954), 540–561.
Rorschach, H., Zur Pathologie und Operabilität der Tumoren der Zirbeldrüse. Beitr. Klin. Chir.83 (1919), 451–474.
Russell, D. S., Rubinstein, L. J., Pathology of tumours of the nervous system, pp. 1–138. London: Arnold. 1959.
Sachs, E., Avman, N., Fisher, R. G., Meningiomas of pineal region and posterior part of third ventricle. J. Neurosurg.19 (1962), 325–331.
Sambasivan, M., Posterior third ventricular tumors. Proceedings of the Fourth European Congress of Neurosurgery, In Present limits of Neurosurgery, pp. 165–168. Prague: Avicenum, Czechoslovak Medical Press. 1972.
Sambasivan, M., Nayar, A., Epidermoid cyst of the pineal region. J. Neurol. Neurosurg. and Psychiat.37 (1974), 1333–1335.
Smaltino, F., Cucciniello, B., Epidermoid tumors of the epiphysial region. J. Neurosurg.28 (1968), 63–66.
Smith, R. A., Pineal tumors. Univ. Mich. Med. Bull.27 (1961), 33–43.
—, Estridge, M. N., Pineal tumors. Handbook Neurol. Vol.17 (1974), 648–665.
Stein, B. M., The infratentorial supracerebellar approach to pineal lesions. J. Neurosurg.35 (1971), 197–202.
—, Fraser, R. A. R., Tenner, M. S., Tumours of the third ventricle in children. J. Neurol. Neurosurg. and Psychiat.35 (1972), 776–788.
Stern, W. E., Batzdorf, U., Rich, J. R., Challenges of surgical excision of tumors in the pineal region. Bull L. A. Neurol. Soc.36 (1971), 105–118.
Suzuki, J., Wada, T., Kowada, M., Clinical observations on tumors of the pineal region. J. Neurosurg.19 (1962), 441–445.
—, Iwabuchi, T., Surgical removal of pineal tumors (pinealomas and teratomas): Experience in a series of 19 cases. J. Neurosurg.23 (1965), 565–571.
—, Hori, S., Evaluation of radiotherapy of tumors in the pineal region by ventriculographic studies with iodized oil. J. Neurosurg.30 (1969), 595–603.
Tompkins, V. N., Haymaker, W., Campbell, E. H., Metastatic pineal tumors; a clinicopathologic report of two cases. J. Neurosurg.7 (1950), 159–169.
Van Wagenen, W. P., A surgical approach for the removal of certain pineal tumors: report of a case. Surg. Gyn. Obstet.53 (1931), 216–220.
Zülch, K. J., Biologie und Pathologie der Hirngeschwülste. Handbuch der Neurochirurgie, III. Band, S. 1–702. Berlin-Göttingen-Heidelberg: Springer. 1956.
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Obrador, S., Soto, M. & Gutierrez-Diaz, J.A. Surgical management of tumours of the pineal region. Acta neurochir 34, 159–171 (1976). https://doi.org/10.1007/BF01405870
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DOI: https://doi.org/10.1007/BF01405870