Skip to main content
SpringerLink
Log in

Neurosurgical Management of Pineal Tumours

  • Chapter
Advances and Technical Standards in Neurosurgery

Part of the book series: Advances and Technical Standards in Neurosurgery ((NEUROSURGERY,volume 27))

Abstract

A variety of tumours arise in the pineal region [44]. Germ cell tumours (GCTs), which is a heterogeneous group of various neoplasms, is the most common type, followed by pineal parenchymal cell tumours, pine-ocytomas and pineoblastomas. Planning of surgical management depends on the biological nature of individual neoplasms and is determined by preoperative radiological findings and an intraoperative histological diagnosis using frozen sections, as well as the surgeon’s experience. Germinoma, which is the most common tumour originating from the pineal body, can be cured by low-dose radiotherapy and chemotherapy, and nowadays needs only to be biopsied. On the other hand, mature teratomas, dermoid or epidermoid cysts, neurocytomas, and meningiomas can be cured by radical surgical resection. Pineal parenchymal tumours and ependymomas require surgical removal and adjuvant radiotherapy. Other tumours, such as malignant teratomas or embryonal carcinomas, need a sophisticated combination therapy including surgery, radiation therapy, and chemotherapy. For such tumours, neurosurgeons should recognize that a surgical resection is only a part of the combination therapy. For instance, application of an appropriate neoadjuvant therapy prior to a radical surgical removal will remarkably reduce the surgical risk for the patients with large malignant pineal tumours.

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

Access this chapter

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 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
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

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Asari S, Maeshiro T, Tomita S, Kawauchi M, Yabuno N, Kinugasa K, Ohmoto T (1995) Meningiomas arising from the falcotentorial junction. J Neurosurg 82: 726–738

    Article  PubMed  CAS  Google Scholar 

  2. Ausman JI, Malik GM, Dujovny M, Mann R (1988) Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 29: 298–306

    Article  PubMed  CAS  Google Scholar 

  3. Brain Tumor Registry of Japan (BTRJ) (1996) the Committee of Brain Tumor Registry of Japan, vol 9. Tokyo, pp 60

    Google Scholar 

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

    Article  CAS  Google Scholar 

  5. Chiechi MV, Smirniotopoulos JG, Mena H (1995) Pineal parenchymal tumors: CT and MR features. J Comput Assist Tomogr 19: 509–171

    Article  PubMed  CAS  Google Scholar 

  6. Clark WK (1987) Occipital transtentorial approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 591–610

    Google Scholar 

  7. D’Andrea AD, Packer RJ, Rorke LB, Bilaniuk LT, Sutton LN, Bruce DA, Schut L (1987) Pineocytomas of childhood. A reappraisal of natural history and response to therapy. Cancer 59: 1353–1357

    Article  PubMed  Google Scholar 

  8. Dandy WE (1921) An operation for the removal of pineal tumors. Surg Gynecol Obset 33: 113–119

    Google Scholar 

  9. Dandy WE (1933) Benign tumors in the third ventricle of the brain: diagnosis and treatment. Charles C Thomas, Springfield

    Google Scholar 

  10. Dandy WE (1936) Operative experience in case of pineal tumor. Arch Surg 33: 19–46

    Article  Google Scholar 

  11. Dearnaley DP, A’Hern RP, Whittaker S, Bloom HJG (1990) Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18: 773–781

    Article  PubMed  CAS  Google Scholar 

  12. Edwards MSB, Hudgins RJ, Wilson CB, Levin VA, Wara WM (1988) Pineal region tumors in children. J Neurosurg 66: 689–697

    Google Scholar 

  13. Ferrer E, Santamaría D, Garcia-Fructuoso G, Garai L, Rumia J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 139: 12–21

    Article  CAS  Google Scholar 

  14. Herrmann HD, Winkler D, Westphal M (1992) Treatment of tumours of the pineal region and posterior part of the third ventricle. Acta Neurochir (Wien) 116: 137–146

    Article  CAS  Google Scholar 

  15. Ishii N, Sawamura Y, de Tribolet N (1997) Treatment of primary intracranial germ cell tumors. Crit Rev Neurosurg 7: 186–192

    Article  Google Scholar 

  16. Jamieson KG (1971) Excision of pineal tumors. J Neurosurg 35: 550–553

    Article  PubMed  CAS  Google Scholar 

  17. Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63: 155–167

    Article  PubMed  CAS  Google Scholar 

  18. Kobayashi S, Sugita K, Tanaka Y, Kyoshima K (1983) Infratentorial approach to the pineal region in the prone position: concorde position. Technical note. J Neurosurg 58:141–143

    Article  PubMed  CAS  Google Scholar 

  19. Konovalov AN, Spallone A, Pitzkhelauri DI (1996) Meningioma of the pineal region: a surgical series of 10 cases. J Neurosurg 85: 586–590

    Article  PubMed  CAS  Google Scholar 

  20. Koide O, Watanabe Y, Sato K (1980) Pathological survey of intracranial germinoma and pinealoma in Japan. Cancer 45: 2119–2307

    Article  PubMed  CAS  Google Scholar 

  21. Krause F (1926) Operative Freilegung der Vierhügel, nebst Beobachtungen bei Hirndruck und Dekompression. Zentralbl Chir 53: 2812–2819

    Google Scholar 

  22. Lapras C, Patet JD (1987) Controversies, techniques and strategies for pineal tumor surgery. In: Appuzo MJL (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 649–662

    Google Scholar 

  23. Lapras C, Patet JD, Mottolese C, Lapras Jr C (1987) Direct surgery for pineal tumors: occipital-transtentorial approach. Prog Exp Tumor Res 30: 268–280

    PubMed  CAS  Google Scholar 

  24. Lavyne MH, Patterson RH (1983) Subchoroidal trans-velum interpositum approach to midthird ventricular tumors. Neurosurgery 12: 86–94

    Article  PubMed  CAS  Google Scholar 

  25. Lazar ML, Clark K (1974) Direct surgical management of masses in the region of the vein of Galen. Surg Neurol 2: 17–21

    PubMed  CAS  Google Scholar 

  26. Matsuno H, Rhoton AL, Peace D (1988) Microsurgical anatomy of the posterior fossa cisterns. Neurosurgery 23: 58–80

    Article  PubMed  CAS  Google Scholar 

  27. Matsushima T, Rhoton AL, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59:63–105

    Article  PubMed  CAS  Google Scholar 

  28. Mena H, Rushing EJ, Ribas JL, Delahunt B, McCarthy WF (1995) Tumors of pineal parenchymal cells: a correlation of histological features, including nucleolar organizer regions, with survival in 35 cases. Hum Pathol 26: 20–30

    Article  PubMed  CAS  Google Scholar 

  29. Murata J, Sawamura Y, Ikeda J, Hashimoto S, Honma K (1998) Twenty-four hour rhythm of melatonin in patients with a history of pineal and/or hypothalamoneurohypophyseal germinoma. J Pineal Res 25(3): 159–166

    Article  PubMed  CAS  Google Scholar 

  30. Nazzaro JM, Shults WT, Neuwelt EA (1992) Neuro-ophthalmological function of patients with pineal region tumors approached trenstentorially in the semisitting position. J Neurosurg 76: 746–751

    Article  PubMed  CAS  Google Scholar 

  31. Oi S, Matsuzawa K, Choi JU, Kim DS, Kang JK, Cho BK (1998) Identical characteristics of the patient populations with pineal region tumors in Japan and in Korea and therapeutic modalities. Childs Nerv Syst 14: 36–40

    Article  PubMed  CAS  Google Scholar 

  32. Ono M, Rhoton AL, Peace D, Rodriguez RJ (1984) Microsurgical anatomy of the deep venous system of the brain. Neurosurgery 15: 621–657

    Article  PubMed  CAS  Google Scholar 

  33. Poppen JL (1966) The right occipital approach to a pinealoma. J Neurosurg 25: 706–710

    Article  PubMed  CAS  Google Scholar 

  34. Poppen JL, Marino R (1968) Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28: 357–364

    Article  PubMed  CAS  Google Scholar 

  35. Quest DO, Kleriga E (1980) Microsurgical anatomy of the pineal region. Neurosurgery 6: 385–390

    Article  PubMed  CAS  Google Scholar 

  36. Reid WS, Clark WK (1978) Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3: 1–8

    Article  PubMed  CAS  Google Scholar 

  37. Saenz A, Zamorano L, Matter A, Bucius R, Diaz F (1998) Interactive image guided surgery of the pineal region. Minim Invasive Neurosurg. 41: 27–30

    Article  PubMed  CAS  Google Scholar 

  38. Sawamura Y, de Tribolet N, Ishii N, Abe H (1997) Surgical management of primary intracranial germinomas: diagnostic surgery or radical resection? J Neurosurg 87: 262–266

    Article  PubMed  CAS  Google Scholar 

  39. Sawamura Y, Shirato H, Ikeda J, Tada M, Ishii M, Kato T, Abe H, Fujieda K (1998) Induction chemotherapy followed by reduced-volume irradiation for newly diagnosed CNS germinoma. J Neurosurg 88: 66–72

    Article  PubMed  CAS  Google Scholar 

  40. Sawamura Y, Ikeda J, Shirato H, Tada M, Abe H (1998) Germ cell tumors of the central nervous system: treatment consideration based on 111 cases and their long-term clinical outcomes. Eur J Cancer 34: 104–110

    Article  PubMed  CAS  Google Scholar 

  41. Sawamura Y (1998) Prognosis of central nervous system germ cell tumors. Intracranial germ cell tumors. In: Sawamura Y, Shirato H, de Tribolet N (eds) Springer, Wien New York, pp 155–168

    Google Scholar 

  42. Sawamura Y (1998) Overview for management. Intracranial germ cell tumors. In: Sawamura Y, Shirato H, de Tribolet N (eds) Springer, Wien New York, pp 169–191

    Chapter  Google Scholar 

  43. Sawamura Y, Kato T, Ikeda J, Tada M, Shirato H (1998) Teratomas of the central nervous system: treatment consideration based on thirty-four cases. J Neurosurg 89: 30–39

    Google Scholar 

  44. Schmidek HH (1977) Pineal tumours. Masson, New York

    Google Scholar 

  45. Shirato H, Sawamura Y (1998) Effect of external radiotherapy. Adverse effect of therapy and late sequelae in survivors. Intracranial germ cell tumors. In: Sawamura Y, Shirato H, de Tribolet N (eds) Springer, Wien New York, pp 317–333

    Google Scholar 

  46. Shokry A, Janzer RC, Von Hochstetter AR, Yasargil MG, Hedinger C (1985) Primary intracranial germ cell tumors. A clinicopathological study of 14 cases. J Neurosurg 62: 826–830

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  48. Stein BM (1979) Surgical treatment of pineal tumors. Clin Neurosurg 26: 490–510

    PubMed  CAS  Google Scholar 

  49. Stein BM (1982) Supracerebellar approach for pineal region neoplasms. Operative neurosurgical technique, vol 1. In: Schmidek H., Sweet W (eds) Grune & Stratton, New York, pp 599–607

    Google Scholar 

  50. Stein BM (1987) Infratentorial supracerebellar approach. In: Apuzzo MJL (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore

    Google Scholar 

  51. Van Wagenen WP (1931) A surgical approach for the removal of certain pineal tumors. Report of a case. Surg Gynecol Obset 53: 216–220

    Google Scholar 

  52. Wolden SL, Wara WM, Larson DA, Prados MD, Edwards MS, Sneed PK (1995) Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32: 943–949

    Article  PubMed  CAS  Google Scholar 

  53. Yamamoto I, Kageyama N (1980) Microsurgical anatomy of the pineal region. J Neurosurg 53: 205–21

    Article  PubMed  CAS  Google Scholar 

  54. Ziyal IM, Sekhar LN, Salas E, Olan WJ (1998) Combined supra/infra tentorial-transsinus approach to large pineal region tumors. J Neurosurg 88: 1050–1057

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Hokkaido University Hospital, Sapporo, Japan

    Y. Sawamura

  2. Department of Neurosurgery, de L’HCUG et du CHUV, Geneva, Switzerland

    N. de Tribolet

Authors
  1. Y. Sawamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. N. de Tribolet
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Cambrigde, UK

    J. D. Pickard (Editor-in-Chief) (Editor-in-Chief)

  2. Ljubljana, Slovenia

    V. V. Dolenc

  3. Lisbon, Portugal

    J. Lobo Antunes

  4. Munich, Germany

    H.-J. Reulen

  5. Lyon, France

    M. Sindou

  6. London, UK

    A. J. Strong

  7. Genève, Switzerland

    N. de Tribolet

  8. Utrecht, The Netherlands

    C. A. F. Tulleken

  9. Kuopio, Finland

    M. Vapalahti

Rights and permissions

Reprints and permissions

Copyright information

© 2002 Springer-Verlag/Wien

About this chapter

Cite this chapter

Sawamura, Y., de Tribolet, N. (2002). Neurosurgical Management of Pineal Tumours. In: Pickard, J.D., et al. Advances and Technical Standards in Neurosurgery. Advances and Technical Standards in Neurosurgery, vol 27. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6174-6_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-7091-6174-6_6

  • Publisher Name: Springer, Vienna

  • Print ISBN: 978-3-7091-3227-2

  • Online ISBN: 978-3-7091-6174-6

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation