Pineoblastoma en el adulto. A propósito de un caso

Fundamento: Los pineoblastomas son tumores cerebrales infrecuentes dentro del grupo de los tumores primitivos neuroectodérmicos. La presentación clínica por lo general está relacionada con la obstrucción del acueducto de Silvio, lo que ocasiona hidrocefalia e hipertensión intracraneal. Objetivo: Describir las características clínicas e imagenológicas de un paciente adulto con diagnóstico de pineoblastoma. Presentación de caso: Masculino, 33 años, que comenzó con disminución de la agudeza visual que evolucionó a la amaurosis bilateral y trastorno de la marcha. Se diagnosticó hidrocefalia obstructiva triventricular, por lo cual se realizó tercer ventriculostomía endoscópica. Se decidió un abordaje supracerebeloso infratentorial a la lesión tumoral, con apoyo endoscópico en posición semisentado; se logró la resección parcial. En estudio inmunohistoquímico se encontró Ki-67 mayor de 50 % de las células, neurofilamento y sinaptofisina positiva. Se concluyó como pineoblastoma. Recibió radioterapia convencional con Co-60, fraccionada, con un total de 30 dosis diarias de 2 Gy. La evolución del paciente a los 6 meses de operado fue satisfactoria. Conclusiones: El tratamiento combinado de cirugía y radioterapia constituye un esquema terapéutico ideal en este tipo de lesiones tumorales. La endoscopia es una herramienta de gran valor en los abordajes quirúrgicos a la región pineal.

Background: Pineoblastomas are infrequent brain tumors among the neuroectodermal primitive tumors. Clinical presentation is usually related to Silvian aqueduct obstruction, which causes hydrocephalus and intracranial hypertension. Objective: To describe the clinical and imagenological characteristics in an adult patient diagnosed with pineoblastoma. Case presentation: Male, 33 years old, who started with visual acuity decline that evolved to bilateral amaurosis and gait disorder. Triventricular obstructive hydrocephalus was diagnosed, therefore, an endoscopic third ventriculostomy was realized. It was decided to use an infratentorial supracerebellar approach to the tumor lesion, with endoscopic support in semi-seated position; partial resection was achieved. In immunohistochemical study, Ki-67 was found to be higher than 50% of the cells, neurofilament and synaptophysin positive. It was concluded as pineoblastoma. He received fractionated Co-60 conventional radiotherapy, with a total of 30 daily doses, 2 Gy. The evolution of the patient 6 months after surgery was satisfactory. Conclusions: The combined treatment of surgery and radiotherapy constitutes an ideal therapeutic scheme in this type of tumor lesions. Endoscopy is a tool of great value in surgical approaches to the pineal region.

Papillary Tumor of the Pineal Region:Report of One Case / 中国医学科学院学报

We report a case of papillary tumor in the pineal region.The imaging findings mainly included:(1)slight high density on CT images;(2)short T1 signal,cystic changes,and evident enhancement on magnetic resonance imaging.

Papillary tumor in pineal region: Immunohistochemistry meeting the diagnostic challenge

Papillary tumor of pineal region (PTPR) is extremely rare and poses diagnostic challenge with other central nervous system tumors having papillary architecture. Immunohistochemistry is crucial for a definitive diagnosis of PTPR.

Pineal gland tumor resection via supracerebellar infratentorial approach under neuroendoscope: a clinical analysis of four cases / 中华神经医学杂志

Objective:To investigate the clinical effacies of endoscopic midline and paramedian supracerebellar infratentorial (SCIT) approaches during resection of pineal tumors.Methods:The clinical data of 4 patients with pineal tumors resected via SCIT approach under neuroendoscope in our hospital from December 2017 to March 2019 were analyzed retrospectively. All patients underwent MR imaging plain and enhanced scans before operation. The tumors were resected via SCIT approach under general anesthesia in lateral subduction position (three were via paramedian SCIT approach and one was via midline SCIT approach). The patients were followed up for 3-12 months and the brain MR imaging was reexamined.Results:The tumors were completely resected in 4 patients. Two patients were confirmed to have mixed germ cell tumors, one was confirmed to have seminoma, and the other one was confirmed to have mature teratoma by postoperative pathology. One achieved good recovery after surgery. Two were treated with whole brain and spinal cord radiotherapy, the original lesion in one patient recurred 4 months after resection and systemic chemotherapy was given, and so far, no recurrence was noted; and the other one achieved good recovery. One did not receive chemoradiotherapy due to economic reasons and relapsed 4 months after surgery.Conclusion:It is safe and effective to resect the tumors in pineal region via midline and paramedian SCIT approaches with neuroendoscopy; the best approach should be selected according to the blood supply, size and location of the lesions.

Resección microquirúrgica de meningioma de la región pineal / Microsurgical resection of meningioma of the pineal region

Introducción: Los meningiomas de la región pineal son lesiones poco frecuentes, representando el 2 al 8% de los tumores localizados en esta área. Estos tumores son lesiones con comportamiento biológicamente benigno y potencialmente curables con la resección quirúrgica radical. A su vez representan un desafío quirúrgico debido a su profunda localización y la cercanía de estructuras anatómicas vitales. El abordaje supracerebeloso infratentorial, en posición semisentado (cuando las condiciones generales del paciente lo permiten), provee un corredor natural a la región pineal mediante la retracción cerebelosa gravitatoria. Objetivo: Presentación de la exéresis microquirúrgica completa de un meningioma de la región pineal. Descripción del caso: Paciente de 52 años que consulta por inestabilidad de la marcha y diplopía de 2 semanas de evolución. La resonancia magnética cerebral mostró una lesión expansiva, que realza con contraste, de 43 x 30 mm en la región pineal, con hidrocefalia obstructiva acompañante. Se realiza la exéresis microquirúrgica mediante abordaje supracerebeloso infratentorial con el paciente en posición semisentado. Resultado: Se realizó la exéresis completa de la lesión. La paciente cursó el primer día postoperatorio en Unidad de Terapia Intensiva y luego pasó a sala de internación general. Fue dada de alta al tercer día, sin déficit neurológico. La anatomía patológica de la lesión informó meningioma transicional (OMS grado I). El control imagenológico postquirúrgico mostró la resección de la lesión sin remanente tumoral. Conclusión: Los meningiomas de la región pineal presentan un desafío quirúrgico debido a la relación con estructuras anatómicas vitales. El abordaje supracerebeloso infratentorial ofrece un corredor anatómico natural mediante la retracción cerebelosa por la gravedad.

Background: Meningiomas of the pineal region are rare lesions representing 2 to 8% of the tumors located in this area. These tumors are lesions with biologically benign behavior and potentially curable by radical surgical resection. As well, they are a surgical challenge due to their deep location and the proximity to vital anatomical structures. The supracerebellar infratentorial approach, in a semisitting position (when the patient's general conditions allow it), provides a natural corridor to the pineal region through gravitational cerebellar retraction. Objetive: Presentation of a complete microsurgical resection of a meningioma of the pineal region. Case description: A 52-year-old patient who consulted due to gait instability and diplopia of 2 weeks of evolution. Brain magnetic resonance showed an expansive lesion, with contrast enhancement, 43 x 30 mm in the pineal region, with obstructive hydrocephalus. The microsurgical resection was performed by supracerebellar infratentorial approach with the patient in a semisitting position. Result: The complete microsurgical resection was achieved. The patient spent the first postoperative day in Intensive Care Unit, and then went to general room. He was discharged on the third postoperative day, without neurological deficit. The histopathology assessment of the lesion reported transitional meningioma (WHO grade I). Post-surgical imaging showed the resection of the lesion without remaining tumor. Conclusion: Meningiomas of the pineal region present a surgical challenge due to the relationship with vital anatomical structures. The supracerebellar infratentorial approach offers a natural anatomical corridor through cerebellar retraction by gravity.

Surgical Treatment of Cavernous Angiomas in the Pineal Gland ­ Case Report

Pineal cavernous angioma is a vascular malformation that has a prevalence lower than 1%. The etiology is debated. It is believed that it is originated from an autosomal dominant inheritance or from radiotherapeutic treatment. Complete resection enables the cure and prevents complications of the natural evolution of the lesion, mainly hemorrhagic events. A female patient, with 67 years of age, presented mental confusion and visual acuity deficit, which evolved to periods of psychomotor agitation. A magnetic resonance imaging (MRI) scan of the head showed a lobulated mass lesion in the pineal region with hypersignal on T1 and hyposignal on the susceptibility weighted imaging (SWI) sequence. Hydrocephalus was also noticed. The patient underwent a microsurgery for complete lesion resection though a supracerebellar/ supratentorial access. The anatomopathology revealed an arteriovenous malformation compatible with cavernous angioma. The pineal cavernous angioma is a rare malformation that should be considered in the differential diagnosis of expansive lesions of the pineal gland.

Prevention and treatment of complications following resection of pineal lesions via modified Poppen approach / 中华神经医学杂志

Objective To explore prevention and treatment of complications following resection of pineal lesions via the modified Poppen approach.Methods From January 2008 to December 2017,62 patients received resection of pineal region lesions via the modified Poppen approach at Department of Neurosurgery,Anhui Provincial Hospital.Their clinical data and outcomes were reviewed.The incidences of postoperative complications were compared between the patients with differences in lesion diameter,tentorial angle and preoperative hydrocephalus.Results Of this cohort,total tumor resection was performed in 48,subtotal resection in 10 and partial resection in 4.Follow-ups from 3 to 12 months revealed 2 cases of hemianopia which were recovered 3 months later,7 cases of occipital lobe contusion,2 cases of monoparesis and 2 cases of intracranial infection.Of the 7 cases of occipital lobe contusion,3 had intracranial hematoma which had been removed by secondary surgery and 4 had ataxia.The incidences of postoperative hemianopia and monoparesis for the patients with a lesion ＞4.5 cm in diameter were significantly higher than for those with a lesion ≤4.5 cm in diameter (P＜0.05).The incidence of postoperative hemianopia for the patients with a tentorial angle ＞60° was significantly higher than for those with a tentorial angle ≤ 60° (P＜0.05).Conclusions Size and tentorial angle of the lesion may be closely associated with the complications following resection of pineal lesions via the modified Poppen approach.The key to reducing the postoperative complications lies in comprehensive preoperative assessments,familiarity with clinical anatomy of the Poppen approach,sophisticated surgical skills and an individualized surgical protocol.

Mature teratoma of the pineal region in the paediatric age group: A case report and review of the literature

@#Introduction: Intracranial teratomas account for 0.5% of all intracranial tumours and 2-4% of intracranial tumours in children. However, in terms of tumours of the pineal area, the exact incidence is not ascertained. Although, it is noted that 50-60% of central nervous system (CNS) germ cell tumours are found in the pineal gland. The degree of difficulty in the sampling of lesions in the pineal gland during biopsy emphasizes the importance of correlating the imaging studies, histopathologic findings, and serum and cerebrospinal fluid (CSF) tumour markers. Case Report: This case report is that of a 9-year-old male who presented with frontal headache of eight days, with associated photophobia, nausea and vomiting, and diplopia. Biopsy with intraoperative navigation was done and the specimen was referred for histopathologic evaluation. The biopsy showed findings consistent with a mature teratoma with no histologic findings of an immature component or secondary somatic malignancy. Comparison of the pre-operative and post-operative multiaxial cranial CT scan showed findings that was consistent with a residual lesion. This was correlated with the pre-operative serum tumour markers which showed alpha-fetoprotein of 22.5 ng/mL and beta-HCG of 1.0 mIU/mL(IU/L), and the post-operative tumour markers of the cerebrospinal fluid that showed alpha-fetoprotein of 3.28 ng/mL and beta-HCG of 18.9 mIU/mL (IU/L). Conclusion: A review of the literature and comparison with current case in relation to the histopathologic, serum and CSF findings, and imaging studies was done to better understand the mechanism of this lesion.

“Somewhere up there”: A case Of pineal gland tumor in a 20-year-old male

@#<p style="text-align: justify;"><strong>BACKGROUND:</strong> Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.<br /><strong>CASE:</strong> A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.<br /><strong>CONCLUSION:</strong> Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.</p>

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

"Somewhere up there": A case of pineal gland tumor in a 20-year-old male

BACKGROUND: Pineal region tumor is a rare and reportable case. Incidence rate adults is 0.025 in 10,000 hence there is no established guidelines among adults  for diagnosis and management of this case.CASE: A case of a 20-year-old male with a two-month history of  intermittent  headache,  occipital  area  with  VAS  5/10,increasing in severity. Until two days prior to admission with severe headache VAS 9-10/10, occipital, and nonradiating.Patient  noted  episodes  of  projectile  vomiting  hence,admitted. Patient presented with non-lateralizing symptoms but  noted  papilledema  and  parinaud  syndrome.Cranial  MRI with contrast revealed a 2.5cm pineal gland tumor with obstructive  hydrocephalus.  Serum  AFP  (alpha-fetoprotein  )  and  beta-HCG  (beta subunit of human chorionic gonadotropin) were requested and revealed elevated levels.The patient underwent endoscopic third ventriculostomy but no biopsy was done due to high risk of bleeding. Patient underwent series of radiotherapy and was advised to undergo chemotherapy but patient refused. Patient had improved upward gaze but with residuals, no recurrence of headache or vomiting, had normalization of the serum tumor markers but noted increase in size of the tumor despite radiotherapy.CONCLUSION: Case  reports  of  pineal  region  tumors  will  help doctors  in  the  primary  hospitals  diagnose  such  cases  and differentiate it from benign causes of headache. This will aid in early referral to specialists and early intervention.

Glioblastoma Multiforme in the Pineal Region with Leptomeningeal Dissemination and Lumbar Metastasis

We report a case of a 31-year-old woman with glioblastoma multiforme (GBM) in the pineal region with associated leptomeningeal dissemination and lumbar metastasis. The patient presented with severe headache and vomiting. Magnetic resonance imaging (MRI) of the brain showed a heterogeneously enhanced tumor in the pineal region with obstructive hydrocephalus. After an urgent ventricular-peritoneal shunt, she was treated by subtotal resection and chemotherapy concomitant with radiotherapy. Two months after surgery, MRI showed no changes in the residual tumor but leptomeningeal dissemination surrounding the brainstem. One month later, she exhibited severe lumbago and bilateral leg pain. Thoracico-lumbar MRI showed drop like metastasis in the lumbar region. Finally she died five months after the initial diagnosis. Neurosurgeons should pay attention to GBM in the pineal region, not only as an important differential diagnosis among the pineal tumors, but due to the aggressive features of leptomeningeal dissemination and spinal metastasis.

Abordaje supracerebeloso infratentorial a la región pineal. técnica, indicaciones y anatomía microquirúrgica en 3D / Supra-adventitious approach to the pineal región. technique, indications and 3D microsurgical anatomy

INTRODUCCIÓN: el abordaje supracerebeloso infratentorial fue descripto originalmente por Sir Victor Horsley, siendo posteriormente adaptado por Stein quien aplica la técnica microquirúrgica mejorando los resultados de las cirugías de la región pineal. OBJETIVOS: resaltar y sistematizar las indicaciones, detalles técnicos-anatómicos en el abordaje supracerebeloso infratentorial en base a nuestra experiencia quirúrgica y la revisión de la anatomía microquirúrgica de la región Pineal. MATERIAL Y MÉTODOS: se realizó un estudio descriptivo retrospectivo analizando las historias clínicas de 7 pacientes intervenidos quirúrgicamente a través de un abordaje supracerebeloso infratentorial, entre septiembre 2010 hasta septiembre 2013 en nuestro servicio. Las imágenes intraquirúrgicas y de preparados anatómicos fueron adquiridas en 3D. La revisión bibliográfica se realizó en Pub Med utilizando las palabras claves: Abordaje Supracerebeloso Infratentorial; Región Pineal; Craniectomía Suboccipital. RESULTADOS: durante el período 2010-2013 fueron intervenidos 7 pacientes. A todos se le practicó un abordaje supracerebeloso infratentorial. Fueron tratados 5 tumores de la región pineal, 1 glioma del culmen cerebeloso y 1 MAV de la fisura cerebelo mesencefálica. Se estandarizaron los siguientes pasos para la realización del abordaje supracerebeloso infratentorial de Stein: preparación prequirúrgica, posición sentado, posición de la cabeza, marcación y antisepsia cutánea, colocación de campos estériles, incisión de piel y tejido celular subcutáneo, disección de plano muscular, craneotomía, apertura dural, preparación del corredor supracerebeloso, disección intradural y anatomía microquirúrgica de la región pineal y consideraciones sobre elcierre. CONCLUSIONES: se sistematizó el abordaje supracerebeloso infratentorial con el que pudimos acceder a tumores pineales y también a lesiones vasculares en la región. En todos los casos la exposición anatómica fue suficiente para tratar en forma adecuada las patologías mencionadas, con mínima retracción de las estructuras del SNC

INTRODUCTION: even though Horsley was the first one to describe the supracerebellar infratentorial approach, it was Stein who adapted it to microsurgical techniques in an attempt to improve the results of surgical procedures on the pineal gland. OBJECTIVES: to enhance the indications and technical details of the supracerebellar infratentorial approach, based upon our experiences, we review the microsurgical anatomy of the pineal region that is exposed via this approach. MATERIALS AND METHODS: a retrospective descriptive study was conducted by analyzing the records of seven patients who had been operated on using this approach at our institution between September 2010 and September 2013. The images shown were obtained in 3D. RESULTS: the indications for surgery in these seven patients were a pineal gland tumor in five patients, and a culmen glioma and mesencephalic-fissure AVM in one patient each. The following steps were standardized according to Stein's description of the supracerebellar infratentorial approach: pre-surgical preparation, sitting position, head position, incision drawing and anti-sepsis, surgical field, collocation, skin and hypodermis incision, muscular dissection, hemostatic control, craniotomy, dural opening, supracerebellar corridor preparation, intradural dissection, microsurgical anatomy study, and considerations regarding closure. CONCLUSIONS: via this approach, we not only have been able to access pineal gland tumors but also vascular lesions in this region. The anatomical exposure achieved was enough to treat these lesions successfully, with minimal manipulation of the CNS

Gamma knife surgery for pineal region tumors: an alternative strategy for negative pathology / Cirurgia com gamma knife como tratamento experimental para tumores da região da pineal: uma estratégia alternativa quando os dados anatomopatológicos são negativos

Objective : Pineal region tumors (PRTs) are uncommon, and treatments vary among neoplasm types. The authors report their experience with gamma knife surgery (GKS) as an initial treatment in a series of PRT patients with unclear pathological diagnoses. Method : Seventeen PRT patients with negative pathology who underwent GKS were retrospectively studied. Nine patients had further whole-brain and spinal cord radiotherapy and chemotherapy 6–9 months after GKS. Results : Sixteen of 17 cases were followed up over a mean of 33.3 months. The total response rate was 75%, and the control rate was 81.3%. No obvious neurological deficits or complications were attributable to GKS. Conclusion : The findings indicate that GKS may be an alternative strategy in selected PRT patients who have negative pathological diagnoses, and that good outcomes and quality of life can be obtained with few complications. .

Tumores da região da pineal (TRP) são pouco frequentes e as propostas de tratamento são bastante variadas. Os autores relatam sua experiência em cirurgias com uso gamma knife (CGK) como tratamento experimental inicial em séries de TRP que não têm diagnóstico anatomopatológico ou nos quais o diagnóstico não ficou claro. Foram estudados retrospectivamente 17 pacientes com TRP nestas condições e que foram submetidos a CGK. Destes, 9 pacientes foram submetidos posteriormente a radioterapia de todo o encéfalo e medula espinhal entre 6 e 9 meses depois da CGK. Dezesseis dos 17 pacientes foram acompanhados por um período médio de 33,3 meses. A taxa total de resposta nos pacientes foi de 75% e a taxa dos controles, 81,3%. Não houve nenhum déficit neurológico evidente que pudesse ser atribuído à CGK. A CGK como tratamento experimental pode ser uma estratégia alternativa no grupo específico de pacientes com TRP em que não há diagnóstico anatomopatológico, podendo ser obtida uma boa qualidade de vida com poucas complicações para esse grupo de pacientes.

Correlación cito-histológica del tumor papilar de la glándula pineal. Presentación de un caso / Papillary pineal tumor: cyto-histological correlation. Case report

En la última revisión de la Organización Mundial de la Salud (OMS) en relación a los tumores del sistema nervioso central (SNC), se describieron nuevas entidades, como el Tumor Papilar de la Glándula Pineal. Esta lesión de rara aparición, se ha identificado en adultos jóvenes. El diagnóstico de estos tumores es complejo ya que depende de su ubicación, edad de aparición y el aspecto histológico; éste último tiene similitudes con otras lesiones como el ependimoma papilar o el papiloma/carcinoma de plexos coroides. Citológicamente presentan características claras que pueden ayudar al diagnóstico a través de la impronta en el estudio intraoperatorio; reconocer ciertos criterios con éste importante y sencillo método diagnóstico ha sido la motivación principal para el estudio de entidades poco frecuentes del SNC, además de corroborar el necesario trabajo de un equipo multidisciplinar.

In the latest revision of the central nervous system tumors (CNS) of the World Health Organization (WHO), new entities has been described, as papillary tumor of the pineal region. This rare lesion has been identified in young adults. The diagnosis of these tumors is complex, depends on the location, age of onset and histological appearance. Histological characteristics have similarities with other lesions such as papillary ependymoma, papiloma / choroid plexus carcinoma. Cytologically have clear characteristics that can aid in the diagnosis through the smears on the intraoperative study. Certain criteria for recognize this important and simple diagnostic method has been the main motivation for the study of CNS rare entities, as our case, in addition to corroborating the necessary work of a multidisciplinary team.

Microsurgical surgery options for tumors in pineal region / 中国综合临床

Objective To explore the significance of surgical resection for the pineal region tumor,the extent of tumor resection,the surgical approaches and treatment measures of hydrocephalus.Methods Twentythree patients diagnosed of pineal region cancer were recruited for this study.Thirteen patients received ventriculo-peritoneal shunt(V-P),during which 7 cases received intraoperative end-plate colostomy.Two of the 13 cases received a second V-P procedure.Another 13 cases received operation by corpus callosum- septum-Dome Room-the third ventricle approach to remove the tumor; Eight cases underwent the tumor resection by suboccipital supratentorial approach (Poppen approach )and 2 cases underwent the tumor resection by the infratentorial cerebellar approach( Krause approach).Results Total tumor resection was performed in 11 cases,subtotal or major total resection in 8 cases and partial resection in 4 cases.Nine cases underwent postoperative radiotherapy alone,8 receiving radiotherapy plus chemotherapy,and 6 cases receiving neither radiotherapy nor chemotherapy.Two cases died during treatment.Conclusion Though it is not practicable to completely remove the germ cell tumor in patients with relatively large tumors,cerebrospinal fluid circulation pathways should be reestablished,including ventriculo-peritoneal shunt,colostomy from the end of the third ventricle to the end plate.If tumors are not too large,they would be easy to be removed.The effects on the surrounding brain tissue would not be much significant.If the connection of Ⅲ,V ventricles were normal,the patient may not need shunt or colostomy.Radiotherapy and chemotherapy can be given to this kind of patients after the surgery.To improve the efficacy,other types of tumors,expecially the benign tumors,should be totally removed.

Neuroendoscopic anatomy of the pineal region / 中华神经医学杂志

Objective To investigate the charateristics of neuroendoscopic anatomy of the pineal region,discuss the anatomy passage and surgical tips of 2 different procedures,and provide anatomical application fundamentals for neuroendoscope-assisted operation of the pineal region.Methods Fifteen specimens of Chinese adult cadaveric head were selected randomly to simulate neuroendoscope-assisted microneurosurgery via suboccipital transtentorial and infratentorial supracerebellar routes.The exposure range and endoscopic adjustable degrees of anatomical structure of the pineal region through different routes were obsevred,and the related data of the anatomical structure via different routes were measured.Results In the simulating operation through suboccipital transtentorial route,the regulation of neuroendoscopy was flexible and both lateral anatomical structures of the pineal region were exposed clearly; in the simulating operation through inffatentorial supracerebellar route,inferior colliculis were not exposed clearly and the view of this route was stiffness and fixed with difficult regulation of the endoscope.The lengh of Galen's vein (GV) is (10.2±4.1) mm,that of internal cerebral vein (ICV) is (35.0±2.8) mm,that of basal vein (BV) is (35.4±6.4) mm and that of straight sinus is (51.1 ±5.2) mm; the angle GV and straight sinus formed (75.20±10.4)°,including acute angle in 14 cases and obtuse angle in 1.The imaginary extension of straight sinus located inferiorly to the splenium of corpus callosum was observed in 3 cases,located tangently to the splenium of corpus callosum in 11 cases,and located superiorly to the splenium of corpus callosum in 1 case.Conclusion Anatomic structures of the pineal region via neuroendosopic suboccipital transtentorial approach are exposed clearly than those via infratentorial supracerebellar approach,however,dissection oftentorium can improve the regulation ofneuroendoscope and exposition ofcontralateral anatomic structure.

CT and MRI characteristics and differential diagnosis of pineal region tumors / 中华神经医学杂志

Objective To analyze the CT and MRI characteristics of the pineal region tumors (PRTs) to improve the accuracy of diagnosis and differential diagnosis.Methods The MRI and CT findings of 28 patients with PRTs proved by operation and pathology were retrospectively analyzed.Eight of them were performed preoperative 1H-MRS and DWI examination and thier data were analyzed too.Results of these 28 patients,11 were diagnosed as having germinoma,4 teratoma,3 astrocytoma,3 meningioma,2 pinealocytoma and 1 epidermoid cyst,1 pineoblastoma,1 hamartoma and 1 dermoidcyst.The main imaging characteristics were cystic tumors in the pineal region,variational density/signal intensity with few tumors having their specified morphology,density/signal intensity and enhancement style.The germinomas and the pineoblastomas were mainly homogeneous solid masses with symmetrical density/signal.The astrocytoma was cystic-solid,mostly,with changing shapes and odds density/signal.The mature teratoma showed blending density/signal.The 1H-MRS showed typical high Cho peak and low NAA peak in the astrocytoma; no NAA peak was found in the meningeoma; high Cho peak and no Lip peak were found in the pineoblastoma; the germinoma was noted having Lip peak.Conclusion Observation on the changes of the morphologic features,density/signal intensity and enhancement style can help in the differential diagnosis of PRTs.DWI and 1H-MRS examinations can improve the accuracy of differential diagnosis to some extent,but some PRTs remain to be non-differentiable.

Clinical pathology of pineal region tumors / 中华神经医学杂志

Objective To investigate the pathological distribution and clinical characteristics of pineal region tumors (PRTs) with variant pathology.Methods We retrospectively analyzed the clinical and pathological data of 133 patients with PRTs that were performed surgical removal from January 2000 to January 2009 in our hospital.Results Sixty-one patients (45.9%) were diagnosed as having germ cell tumors,17 (12.8%) pineal parenchymal tumors,28 (21.1%) gliomas and 27 (20.2%)other resource tumors.Sex ratio of patients with germ cell tumors,pineal parenchymal tumors and gliomas were 14.25:1 (male:female),2.4:1 and 1.15:1,respectively; their median ages were 15.3,24.7 and 28.1,respectively.The serum immunologic test showed abnormal results in 33 patients; except for 1 with metastatic tumors,the others were diagnosed as having germ cell tumors.Conclusion PRTs have many pathological types and patients with PRTs are mainly diagnosed as having germ cell tumors.Correct diagnosis can not be made by imaging,serum immunologic test or biopsy, thus,obtaining complete clinical specimen during the total tumor removal is very necessary in studying the pathology of PRTs.

Contrasted study between thin coronal sectional anatomy of the pineal region and MRI image / 解剖学报

Objective To investigate the morphology and relationships with the adjacent structures in the pineal region on the thin sections and to provide anatomic data for imaging diagnosis and surgical treatment of diseases in this region. Methods By CT and MRI examination, one normal head specimen was selected for this study. Using the computerized freezing milling technique, the specimen was sliced from anterior to posterior. The in vivo MR images were obtained from ten normal Chinese male adult volunteers using a 3.0 T GE scanner. The base lines of the sectioning and the MR scan were perpendicular to the AC-PC line. Then primary sections were contrasted with the corresponding MR images. Results By the appearance of the pineal peduncle and the disappearance of the pineal gland, the pineal region could be divided into three parts from anterior to posterior, and the shape changed from an inverted triangle to a trapezoid and a triangle gradually. The first interspace was getting wider in the anterior and middle parts of the pineal region, while in the posterior part of the pineal region, it was getting narrower and disappeared finally. From anterior to posterior, the bilateral internal cerebral veins were always in the midline of the pineal region and descended gradually.Conclusion By the computerized freezing milling technique, the anatomic details and adjacent relationships of the pineal region could be exhibited clearly in the thin serial sections, which could help the imaging diagnosis and surgical treatments for minute diseases in this region.