Skip to main content
SpringerLink
Log in
Book cover

Advances and Technical Standards in Neurosurgery pp 79–102Cite as

Pineal Lesions: A Multidisciplinary Challenge

  • Chapter
  • First Online:

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 42))

Abstract

The pineal region is a complex anatomical compartment, harbouring the pineal gland surrounded by the quadrigeminal plate and the confluents of the internal cerebral veins to form the vein of Galen. The complexity of lesions in that region, however, goes far beyond the pineal parenchyma proper. Originating in the pineal gland, there are not only benign cysts but also numerous different tumour types. In addition, lesions such as tectal gliomas, tentorial meningiomas and choroid plexus papillomas arise from the surrounding structures, occupying that regions. Furthermore, the area has an affinity for metastatic lesions. Vascular lesions complete the spectrum mainly as small tectal arteriovenous malformations or cavernous haemangiomas.

Taken together, there is a wide spectrum of lesions, many unique to that region, which call for a multidisciplinary approach. The limited access and anatomical complexity have generated a spectrum of anatomical approaches and raised the interest for neuroendoscopic approaches. Equally complex is the spectrum of treatment modalities such as microsurgery as the main option but stereotactic radiosurgery as an alternative or adjuvant to surgery for selected cases, radiation as for germinoma (see below) and or combinatorial chemotherapy, which may need to precede any other ablative technique as constituents.

In this context, we review the current literature and our own series to obtain a snapshot sentiment of how to approach pineal lesions, how to interrelate alternative/competing concepts and review the recent technological advances.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Al-Hussaini M et al (2009) Pineal gland tumors: experience from the SEER database. J Neurooncol 94(3):351–358

    Article  PubMed Central  PubMed  Google Scholar 

  2. Al-Tamimi YZ et al (2008) Endoscopic biopsy during third ventriculostomy in paediatric pineal region tumours. Childs Nerv Syst 24(11):1323–1326

    Article  PubMed  Google Scholar 

  3. Amendola MA et al (1984) Pineal region tumors: analysis of treatment results. Int J Radiat Oncol Biol Phys 10(7):991–997

    Article  CAS  PubMed  Google Scholar 

  4. Blakeley JO, Grossman SA (2006) Management of pineal region tumors. Curr Treat Options Oncol 7(6):505–516

    Article  PubMed  Google Scholar 

  5. Bruce JN (2012) Management of pineal region tumors. In: Quinones-Hinojosa A (ed) Schmidek & Sweet operative neurosurgical techniques, 6th revised edn. Elsevier Saunders, Philadelphia pp 357–366.

    Google Scholar 

  6. Bruce JN, Ogden AT (2004) Surgical strategies for treating patients with pineal region tumors. J Neurooncol 69(1–3):221–236

    Article  PubMed  Google Scholar 

  7. Bruce JN, Stein BM (1995) Surgical management of pineal region tumors. Acta Neurochir 134(3–4):130–135

    Article  CAS  PubMed  Google Scholar 

  8. Buffenoir K et al (2008) Papillary tumor of the pineal region in a child: case report and review of the literature. Childs Nerv Syst 24(3):379–384

    Article  PubMed  Google Scholar 

  9. Calaminus G et al (2005) AFP/beta-HCG secreting CNS germ cell tumors: long-term outcome with respect to initial symptoms and primary tumor resection. Results of the cooperative trial MAKEI 89. Neuropediatrics 36(2):71–77

    Article  CAS  PubMed  Google Scholar 

  10. Carrillo-Vico A et al (2006) The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs 7(5):423–431

    CAS  PubMed  Google Scholar 

  11. Chang SM et al (1995) Pineoblastoma in adults. Neurosurgery 37(3):383–390; discussion 390–391

    Article  CAS  PubMed  Google Scholar 

  12. Cho BK et al (1998) Pineal tumors: experience with 48 cases over 10 years. Childs Nerv Syst 14(1–2):53–58

    Article  CAS  PubMed  Google Scholar 

  13. Choi JU et al (1998) Treatment of germ cell tumors in the pineal region. Childs Nerv Syst 14(1–2):41–48

    Article  CAS  PubMed  Google Scholar 

  14. Choudhry O et al (2011) On the surgery of the seat of the soul: the pineal gland and the history of its surgical approaches. Neurosurg Clin N Am 22(3):321–333, vii

    Article  PubMed  Google Scholar 

  15. Choy et al (2011) Pineal cyst: a review of clinical and radiological features. Neurosurg Clin N Am 22(3):341–351, vii

    Article  PubMed  Google Scholar 

  16. Clark AJ et al (2010) Factors influencing overall survival rates for patients with pineocytoma. J Neurooncol 100(2):255–260

    Article  PubMed Central  PubMed  Google Scholar 

  17. Cuccia V et al (2006) Pinealoblastomas in children. Childs Nerv Syst 22(6):577–585

    Article  PubMed  Google Scholar 

  18. Domínguez-Alonso A et al (2012) Melatonin increases dendritogenesis in the hilus of hippocampal organotypic cultures. J Pineal Res 52(4):427–436

    Article  PubMed  Google Scholar 

  19. Drummond KJ, Rosenfeld JV (1999) Pineal region tumours in childhood. A 30-year experience. Childs Nerv Syst 15(2–3):119–26; discussion 127

    Google Scholar 

  20. Dumrongpisutikul N et al (2012) Distinguishing between germinomas and pineal cell tumors on MR imaging. AJNR Am J Neuroradiol 33(3):550–555

    Article  CAS  PubMed  Google Scholar 

  21. Engel U et al (2000) Cystic lesions of the pineal region – MRI and pathology. Neuroradiology 42(6):399–402

    Article  CAS  PubMed  Google Scholar 

  22. Fakhran S, Escott EJ (2008) Pineocytoma mimicking a pineal cyst on imaging: true diagnostic dilemma or a case of incomplete imaging? AJNR Am J Neuroradiol 29(1):159–163

    Article  CAS  PubMed  Google Scholar 

  23. Fauchon F et al (2000) Parenchymal pineal tumors: a clinicopathological study of 76 cases. Int J Radiat Oncol Biol Phys 46(4):959–968

    Article  CAS  PubMed  Google Scholar 

  24. Fèvre-Montange M et al (2006) Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol 65(10):1004–1011

    Article  PubMed  Google Scholar 

  25. Franzini A et al (1998) Long-term follow-up of germinoma after stereotactic biopsy and brain radiotherapy: a cell kinetics study. J Neurol 245(9):593–597

    Article  CAS  PubMed  Google Scholar 

  26. Gilheeney SW et al (2008) Outcome of pediatric pineoblastoma after surgery, radiation and chemotherapy. J Neurooncol 89(1):89–95

    Article  PubMed  Google Scholar 

  27. Greene MW (2012) Circadian rhythms and tumor growth. Cancer Lett 318(2):115–123

    Article  CAS  PubMed  Google Scholar 

  28. Hanft SJ et al (2011) Stereotactic radiosurgery for pineal region tumors. Neurosurg Clin N Am 22(3):413–420, ix

    Article  PubMed  Google Scholar 

  29. Herrmann HD et al (1994) Treatment of nongerminomatous germ-cell tumors of the pineal region. Neurosurgery 34(3):524–529; discussion 529

    Article  CAS  PubMed  Google Scholar 

  30. Horrax G (1947) The role of pinealomas in the causation of diabetes insipidus. Ann Surg 126(5):725–739

    Article  PubMed Central  Google Scholar 

  31. Ingold B et al (2006) Abdominal seeding of an atypical teratoid/rhabdoid tumor of the pineal gland along a ventriculoperitoneal shunt catheter. Acta Neuropathol 111(1):56–59

    Article  PubMed  Google Scholar 

  32. Janss AJ, Mapstone TB (2010) Pineal region tumors in children. In: Tonn JC, Westphal M, Rutka JT, Grossman SA (eds) Oncology of CNS tumors. Springer, Berlin/Heidelberg/New York

    Google Scholar 

  33. Jouvet A et al (2003) Papillary tumor of the pineal region. Am J Surg Pathol 27(4):505–512

    Article  PubMed  Google Scholar 

  34. Kalra S et al (2012) The reno-pineal axis: a novel role for melatonin. Indian J Endocrinol Metab 16(2):192–194

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  35. Konovalov AN, Pitskhelauri DI (2003) Principles of treatment of the pineal region tumors. Surg Neurol 59(4):250–268

    Article  PubMed  Google Scholar 

  36. Kreth et al (1996) Stereotactic management of lesions of the pineal region. Neurosurgery 39(2):280–289; discussion 289–291

    Google Scholar 

  37. Li Y (2011) Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen’s approach: a report of ten cases and a literature review. World J Surg Oncol 9:64

    Article  PubMed Central  PubMed  Google Scholar 

  38. Maarouf M et al (2010) Pineal parenchymal tumors. Management with interstitial iodine-125 radiosurgery. Strahlenther Onkol 186(3):127–134

    Article  PubMed  Google Scholar 

  39. Mandera M et al (2003) Pineal cysts in childhood. Childs Nerv Syst 19(10–11):750–755

    Article  PubMed  Google Scholar 

  40. Morgenstern PF, Souweidane M (2012) Pineal region tumors: simultaneous endoscopic third ventriculostomy (ETV) and tumor biopsy. World Neurosurg 30(4):E3

    Google Scholar 

  41. Murray MJ et al (2011) Intra-abdominal metastasis of an intracranial germinoma via ventriculo-peritoneal shunt in a 13-year-old female. Br J Neurosurg 25(6):747–749

    Article  PubMed  Google Scholar 

  42. Nomura K (2001) Epidemiology of germ cell tumors in Asia of pineal region tumor. J Neurooncol 54(3):211–217

    Article  CAS  PubMed  Google Scholar 

  43. Osuka S et al (2007) Long-term outcome of patients with intracranial germinoma. J Neurooncol 83(1):71–79

    Article  PubMed  Google Scholar 

  44. Parker JJ, Waziri A (2011) Preoperative evaluation of pineal tumors. Neurosurg Clin N Am 22(3):353–358, vii-viii

    Article  PubMed  Google Scholar 

  45. Pitskhelauri D et al (2004) Iatrogenic metastasis of pineal tumors. Zh Vopr Neirokhir Im N N Burdenko 4:28–33; discussion 33–34

    PubMed  Google Scholar 

  46. Pople IK et al (2001) The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours. Br J Neurosurg 15(4):305–311

    Article  CAS  PubMed  Google Scholar 

  47. Pu et al (2007) High prevalence of pineal cysts in healthy adults demonstrated by high-resolution, noncontrast brain MR imaging. Am J Neuroradiol 28(9):1706–1709

    Google Scholar 

  48. Regis J et al (1996) Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 39(5):907–912; discussion 912–914

    CAS  PubMed  Google Scholar 

  49. Santoro A et al (2011) Four-year clinical and neuroradiological follow-up of a papillary tumor of the pineal region. Neurol Sci 33(4):931–935

    Article  PubMed  Google Scholar 

  50. Schild SE et al (1993) Pineal parenchymal tumors. Clinical, pathologic, and therapeutic aspects. Cancer 72(3):870–880

    Article  CAS  PubMed  Google Scholar 

  51. Schild SE et al (1996) Histologically confirmed pineal tumors and other germ cell tumors of the brain. Cancer 78(12):2564–2571

    Article  CAS  PubMed  Google Scholar 

  52. Sood S et al (2011) Pure endoscopic removal of pineal region tumors. Childs Nerv Syst 27(9):1489–1492

    Article  PubMed  Google Scholar 

  53. Stein BM (1971) The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35(2):197–202

    Article  CAS  PubMed  Google Scholar 

  54. Stein BM, Bruce JN (1992) Surgical management of pineal region tumors (honored guest lecture). Clin Neurosurg. 39:509–32.

    CAS  PubMed  Google Scholar 

  55. Tate MC et al (2011) Contemporary management of pineoblastoma. Neurosurg Clin N Am 22(3):409–412, ix

    Article  PubMed  Google Scholar 

  56. Ternier J et al (2006) Tectal plate lesions in children. J Neurosurg 104(6 Suppl):369–376

    PubMed  Google Scholar 

  57. Vaquero J et al (1992) Neurosurgical experience with tumours of the pineal region at Clinica Puerta de Hierro. Acta Neurochir 116(1):23–32

    Article  CAS  PubMed  Google Scholar 

  58. Wilson DA et al (2012) Long-term radiosurgical control of subtotally resected adult pineocytomas. J Neurosurg 117(2):212–217

    Article  PubMed  Google Scholar 

  59. Yamini B et al (2004) Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg 100(5 Suppl Pediatrics):437–441

    PubMed  Google Scholar 

  60. Yianni J et al (2011) Stereotactic radiosurgery for pineal tumours. Br J Neurosurg 26(3):361–366

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany

    Manfred Westphal & Pedram Emami

Authors
  1. Manfred Westphal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pedram Emami
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pedram Emami .

Editor information

Editors and Affiliations

  1. Medizinische Fakultät, Univ.Klinikum Bonn Med. Einrichtungen, Bonn, Germany

    Johannes Schramm

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Westphal, M., Emami, P. (2015). Pineal Lesions: A Multidisciplinary Challenge. In: Schramm, J. (eds) Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 42. Springer, Cham. https://doi.org/10.1007/978-3-319-09066-5_5

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-09066-5_5

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-09065-8

  • Online ISBN: 978-3-319-09066-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation