Abstract
The therapeutic modalities for pineal region tumors in Western countries differ from those in far-eastern countries, that is, Japan and Korea, mainly because of the different patient populations. The majority of pineal region tumors in Japan and Korea are radio sensitive and/or chemosensitive, and adjuvant therapy rather than extensive surgery plays the main part in the treatment of these tumors. The authors have applied minimally-invasive preferential management in pineal region tumors in last 8 years. For the therapeutic regimen, if the tumor markers alpha-fetoprotein (AFP) and human chorionic gonadotropin (HCG) were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third-ventriculostomy. In the results, our minimally-invasive preferential regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure. Then avoided unnecessary craniotomy and radiotherapy and promised excellent therapeutic outcomes. Neuroendoscopic procedures have a great advantage in the management of chemo- or radiosensitive tumors, such as germinoma, pineoblastoma, or primitive neuroectodermal tumor. The neuroendoscopic anatomy including the lateral and third ventricles with a pineal region tumor with or without tumor dissemination was described in detail, together with the neuroendoscopic surgical technique.
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References
Edwards MSB, Hudgins RJ, Wilson CB, Levin VA, Wara WM: Pineal region tumors in children. J Neurosurg 68: 689–697, 1988
Allen JC, Nisselbaum J, Epstein F, Rosen G, Schwartz MK: Alphafetoprotein and human chorionic gonadotropin determination in cerebrospinal fluid. An aid to the diagnosis and management of intracranial germ-cell tumors. J Neurosurg 51: 368–374, 1979
Anonymous: A statistical study of brain tumors in Japan: general features. The Committee of the Brain Tumor Registry of Japan. Jpn J Clin Oncol 17: 19–28, 1987
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 8: 332–336, 1992
Oi S, Matsuzawa K, Choi JU, Kim Ds, Kang JK, Cho BK: Identical characteristics of the patient populations with pineal region tumors in Japan and in Korea and therapeutic modalities. Childs Nerv Syst 14: 36–40, 1998
Allen JC: Management of primary intracranial germ cell tumors of childhood. Pediatr Neurosci 13: 152–157, 1987
Poppen IL, Marino R Jr: Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28: 357–364, 1968
Allen JC, Kim JH, Packer RJ: Neoadjuvant chemotherapy for newly diagnosed germ-cell tumors of the central nervous system. J Neurosurg 67: 65–70, 1987
Oi S, Hidaka M, Honda Y, Togo K, Shinoda M, Shimoda M, Tsugane R, Sato O: Neuroendoscopic Surgery for Specific Forms of Hydrocephalus. Childs Nerv Syst 15: 56–68, 1999
Oi S, Matsumoto S: Manometric ventricular trocar - A new shunt trocar with intraventricular pressure monitoring fluid pathway. Neurol Med Chir 28: 559–561, 1988
Oi S: Recent advances in neuroendoscopic surgery: realistic indications and clinical achievements. Crit Rev Neurosurg 6: 64–72, 1996
Gaab MR, Schroeder HWS: Neuroendoscopic approach to intraventricular lesions. J Neurosurg 88: 496–505, 1998
Oi S, Shibata M, Tominaga J, Honda Y, Shinoda M, Takei F, Tsugane R, Matsuzawa K, Sato O: Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study. J Neurosurg 93: 245–253, 2000
Cohen AR: Endoscopic ventricular surgery. Pediatr Neurosurg 19: 127–134, 1993
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Oi, S., Kamio, M., Joki, T. et al. Neuroendoscopic anatomy and surgery in pineal region tumors. J Neurooncol 54, 277–286 (2001). https://doi.org/10.1023/A:1012754616544
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DOI: https://doi.org/10.1023/A:1012754616544