Neurosurgical Management of Pineal Tumours

  • Y. Sawamura
  • N. de Tribolet
Part of the Advances and Technical Standards in Neurosurgery book series (NEUROSURGERY, volume 27)


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.


Pineal Region Basal Vein Straight Sinus Pineal Body Great Vein 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 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: 726–738PubMedCrossRefGoogle Scholar
  2. 2.
    Ausman JI, Malik GM, Dujovny M, Mann R (1988) Three-quarter prone approach to the pineal-tentorial region. Surg Neurol 29: 298–306PubMedCrossRefGoogle Scholar
  3. 3.
    Brain Tumor Registry of Japan (BTRJ) (1996) the Committee of Brain Tumor Registry of Japan, vol 9. Tokyo, pp 60Google Scholar
  4. 4.
    Bruce JN, Stein BM (1995) Surgical Management of pineal region tumors. Acta Neurochir (Wien) 134: 130–135CrossRefGoogle Scholar
  5. 5.
    Chiechi MV, Smirniotopoulos JG, Mena H (1995) Pineal parenchymal tumors: CT and MR features. J Comput Assist Tomogr 19: 509–171PubMedCrossRefGoogle Scholar
  6. 6.
    Clark WK (1987) Occipital transtentorial approach. In: Apuzzo MLJ (ed) Surgery of the third ventricle. Williams & Wilkins, Baltimore, pp 591–610Google Scholar
  7. 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: 1353–1357PubMedCrossRefGoogle Scholar
  8. 8.
    Dandy WE (1921) An operation for the removal of pineal tumors. Surg Gynecol Obset 33: 113–119Google Scholar
  9. 9.
    Dandy WE (1933) Benign tumors in the third ventricle of the brain: diagnosis and treatment. Charles C Thomas, SpringfieldGoogle Scholar
  10. 10.
    Dandy WE (1936) Operative experience in case of pineal tumor. Arch Surg 33: 19–46CrossRefGoogle Scholar
  11. 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: 773–781PubMedCrossRefGoogle Scholar
  12. 12.
    Edwards MSB, Hudgins RJ, Wilson CB, Levin VA, Wara WM (1988) Pineal region tumors in children. J Neurosurg 66: 689–697Google Scholar
  13. 13.
    Ferrer E, Santamaría D, Garcia-Fructuoso G, Garai L, Rumia J (1997) Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 139: 12–21CrossRefGoogle Scholar
  14. 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: 137–146CrossRefGoogle Scholar
  15. 15.
    Ishii N, Sawamura Y, de Tribolet N (1997) Treatment of primary intracranial germ cell tumors. Crit Rev Neurosurg 7: 186–192CrossRefGoogle Scholar
  16. 16.
    Jamieson KG (1971) Excision of pineal tumors. J Neurosurg 35: 550–553PubMedCrossRefGoogle Scholar
  17. 17.
    Jennings MT, Gelman R, Hochberg F (1985) Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63: 155–167PubMedCrossRefGoogle Scholar
  18. 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 58:141–143PubMedCrossRefGoogle Scholar
  19. 19.
    Konovalov AN, Spallone A, Pitzkhelauri DI (1996) Meningioma of the pineal region: a surgical series of 10 cases. J Neurosurg 85: 586–590PubMedCrossRefGoogle Scholar
  20. 20.
    Koide O, Watanabe Y, Sato K (1980) Pathological survey of intracranial germinoma and pinealoma in Japan. Cancer 45: 2119–2307PubMedCrossRefGoogle Scholar
  21. 21.
    Krause F (1926) Operative Freilegung der Vierhügel, nebst Beobachtungen bei Hirndruck und Dekompression. Zentralbl Chir 53: 2812–2819Google Scholar
  22. 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 649–662Google Scholar
  23. 23.
    Lapras C, Patet JD, Mottolese C, Lapras Jr C (1987) Direct surgery for pineal tumors: occipital-transtentorial approach. Prog Exp Tumor Res 30: 268–280PubMedGoogle Scholar
  24. 24.
    Lavyne MH, Patterson RH (1983) Subchoroidal trans-velum interpositum approach to midthird ventricular tumors. Neurosurgery 12: 86–94PubMedCrossRefGoogle Scholar
  25. 25.
    Lazar ML, Clark K (1974) Direct surgical management of masses in the region of the vein of Galen. Surg Neurol 2: 17–21PubMedGoogle Scholar
  26. 26.
    Matsuno H, Rhoton AL, Peace D (1988) Microsurgical anatomy of the posterior fossa cisterns. Neurosurgery 23: 58–80PubMedCrossRefGoogle Scholar
  27. 27.
    Matsushima T, Rhoton AL, de Oliveira E, Peace D (1983) Microsurgical anatomy of the veins of the posterior fossa. J Neurosurg 59:63–105PubMedCrossRefGoogle Scholar
  28. 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: 20–30PubMedCrossRefGoogle Scholar
  29. 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): 159–166PubMedCrossRefGoogle Scholar
  30. 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: 746–751PubMedCrossRefGoogle Scholar
  31. 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: 36–40PubMedCrossRefGoogle Scholar
  32. 32.
    Ono M, Rhoton AL, Peace D, Rodriguez RJ (1984) Microsurgical anatomy of the deep venous system of the brain. Neurosurgery 15: 621–657PubMedCrossRefGoogle Scholar
  33. 33.
    Poppen JL (1966) The right occipital approach to a pinealoma. J Neurosurg 25: 706–710PubMedCrossRefGoogle Scholar
  34. 34.
    Poppen JL, Marino R (1968) Pinealomas and tumors of the posterior portion of the third ventricle. J Neurosurg 28: 357–364PubMedCrossRefGoogle Scholar
  35. 35.
    Quest DO, Kleriga E (1980) Microsurgical anatomy of the pineal region. Neurosurgery 6: 385–390PubMedCrossRefGoogle Scholar
  36. 36.
    Reid WS, Clark WK (1978) Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 3: 1–8PubMedCrossRefGoogle Scholar
  37. 37.
    Saenz A, Zamorano L, Matter A, Bucius R, Diaz F (1998) Interactive image guided surgery of the pineal region. Minim Invasive Neurosurg. 41: 27–30PubMedCrossRefGoogle Scholar
  38. 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: 262–266PubMedCrossRefGoogle Scholar
  39. 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: 66–72PubMedCrossRefGoogle Scholar
  40. 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: 104–110PubMedCrossRefGoogle Scholar
  41. 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 155–168Google Scholar
  42. 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 169–191CrossRefGoogle Scholar
  43. 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: 30–39Google Scholar
  44. 44.
    Schmidek HH (1977) Pineal tumours. Masson, New YorkGoogle Scholar
  45. 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 317–333Google Scholar
  46. 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: 826–830PubMedCrossRefGoogle Scholar
  47. 47.
    Stein BM (1971) The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 35: 197–202PubMedCrossRefGoogle Scholar
  48. 48.
    Stein BM (1979) Surgical treatment of pineal tumors. Clin Neurosurg 26: 490–510PubMedGoogle Scholar
  49. 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 599–607Google Scholar
  50. 50.
    Stein BM (1987) Infratentorial supracerebellar approach. In: Apuzzo MJL (ed) Surgery of the third ventricle. Williams & Wilkins, BaltimoreGoogle Scholar
  51. 51.
    Van Wagenen WP (1931) A surgical approach for the removal of certain pineal tumors. Report of a case. Surg Gynecol Obset 53: 216–220Google Scholar
  52. 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: 943–949PubMedCrossRefGoogle Scholar
  53. 53.
    Yamamoto I, Kageyama N (1980) Microsurgical anatomy of the pineal region. J Neurosurg 53: 205–21PubMedCrossRefGoogle Scholar
  54. 54.
    Ziyal IM, Sekhar LN, Salas E, Olan WJ (1998) Combined supra/infra tentorial-transsinus approach to large pineal region tumors. J Neurosurg 88: 1050–1057PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2002

Authors and Affiliations

  • Y. Sawamura
    • 1
  • N. de Tribolet
    • 2
  1. 1.Hokkaido University HospitalSapporoJapan
  2. 2.Department of Neurosurgeryde L’HCUG et du CHUVGenevaSwitzerland

Personalised recommendations