[Analysis of the surgical strategy for the treatment of pineal region tumors].

Abstract

OBJECTIVE:

To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

• Authors: Guoqiang Xie, Xiaolei Chen, Jiashu Zhang, Fangye Li, Guochen Sun, Xinguang Yu
• Journal: Zhonghua wai ke za zhi [Chinese journal of surgery] (Zhonghua Wai Ke Za Zhi) Vol. 52 Issue 8 Pg. 584-8 (Aug 2014) ISSN: 0529-5815 [Print] China
• PMID: 25370757 (Publication Type: English Abstract, Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adolescent
• Adult
• Brain Neoplasms (surgery)
• Child
• Child, Preschool
• Female
• Follow-Up Studies
• Humans
• Hydrocephalus (pathology)
• Infant
• Male
• Middle Aged
• Pineal Gland
• Pinealoma (surgery)
• Prognosis
• Retrospective Studies
• Treatment Outcome
• Ventriculostomy
• Young Adult