A Clinical Analysis on the Pineal Region Tumors

ABSTRACT

The authors analyzed 24 cases of the pineal region tumors which were treated at the Department of Neurosurgery, Yonsei University during the last eight years. Tumors of the pineal region constitutes 2.5% of all brain tumors in authors' series. Most(79.1%) of the patients were younger than 20. Of these 24 cases, 19 were male and 5 were female. Presenting symptoms were headache, vomitting and clouding of sonsciousness due to obstructive hydrocephalus, followed by eye signs, such as Parinaud's syndrome, abducens palsy, and papilledema. Other signs are ataxia and hemiplegia. Plain skull films showed abnormal calcifications and findings of increased intracranial pressure. Location and size of the tumors were most accurately visualized by the brain CT scan. Pathological types of the pineal tumors could be differentiated by the brain CT scan from the patterns of contrast enhancement and tumor density. Among the 24 patients received VP shunt surgery for hydrocephalus. Eighteen patients had the radiation therapy either after the surgery or radiation alone. Germinoma was the most frequent type of pineal region tumors in this series, accounting for half of the patients who had the surgery. There was no immediate postoperative mortality, but one patient with pineoblastoma died from multiple spinal seeding nine months after the surgery. In conclusion, it is most important to identify the pathological type of the tumors in pineal region, because the prognosis of the patient as well as the mode of treatment varies according to the pathological diagnosis. Stereotaxic biopsy of the pineal region tumors is the most accurate diagnostic methods in authors' series among such other methods as brain CT scan, CSF cytology and/or tumor marker study.