Analysis of the surgical strategy for the treatment of pineal region tumors / 中华外科杂志
Chinese Journal of Surgery
; (12): 584-588, 2014.
Article
in Zh
| WPRIM
| ID: wpr-336713
Responsible library:
WPRO
ABSTRACT
<p><b>OBJECTIVE</b>To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors.</p><p><b>METHODS</b>From September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. All the patients routinely underwent endoscopic third ventriculostomy (ETV) and tumor biopsy as the initial treatment. Twenty-seven cases (62.8%, pure endoscopic group) with histological diagnosis of germinoma (23 cases) or pineoblastoma (4 cases) were treated with chemotherapy with/without radiation therapy after ETV. The rest 16 cases (37.2%, craniotomy group) with histological diagnosis of non-germinoma and non-pineoblastoma (5 astrocytomas, 4 pineocytomas, 4 teratomas, 2 ependymomas, and 1 pineopappiloma) had craniotomy and tumor resection after ETV. All the cases had routine follow-up at 1, 3, and 6 months after the final surgery. The clinical, imaging, and tumor markers analysis were routinely examined at follow-up.</p><p><b>RESULTS</b>In the pure endoscopic group, 1 case had intra-ventricular hemorrhage after ETV, followed by external ventricular drainage and recovered after 1 week. Endoscopic procedure related short-term ( < 3 months) complication rate was 2.3% (1/43), while long-term morbidity was 0. All cases in the pure endoscopic group had chemotherapy with/without radiation therapy. Long-term follow-up results showed that all cases were cured or had progression free survival (PFS). In the craniotomy group, 2 cases (2/16) developed intra-cranial hemorrhage after surgery, and had to be operated again for hematoma evacuation. In the craniotomy group, the short-term ( < 3 months) morbidity rate was 6/16. At 3 months follow-up, 1 case still had homonymous hemianopia, which made the long-term morbidity rate was 1/16.</p><p><b>CONCLUSIONS</b>For pineal region tumors with non-communicating hydrocephalus, simultaneous ETV with tumor biopsy can be the most favorable initial diagnostic and therapeutic treatment. Second-stage treatment (chemotherapy, radiation therapy, or craniotomy with tumor resection) can be selected according to the histological diagnosis.</p>
Full text:
1
Index:
WPRIM
Main subject:
Pathology
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Pineal Gland
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Pinealoma
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Prognosis
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General Surgery
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Brain Neoplasms
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Ventriculostomy
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Retrospective Studies
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Follow-Up Studies
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Treatment Outcome
Type of study:
Observational_studies
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Prognostic_studies
Limits:
Adolescent
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Adult
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Child
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Child, preschool
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Female
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Humans
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Infant
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Male
Language:
Zh
Journal:
Chinese Journal of Surgery
Year:
2014
Type:
Article