1
|
Porto Sousa M, Gomes Cabral Junior S, Virgilio Ribeiro F, Nunes Pustilnik H, Yuri Ferreira M, Verly G, Pedro Bittar Sanches J, Snyder Crespo Zavala N, Muszkat Besborodco R, Vinicius Figueredo Almeida C, Oliveira LB, Batista S, Campos Gomes Pinto F, Bertani R. Good clinical outcomes and the necessity of CSF drainage in patients undergoing simultaneous biopsy and endoscopic third ventriculostomy in the region of pineal tumors: A systematic review and meta-analysis. J Clin Neurosci 2024; 126:234-244. [PMID: 38970969 DOI: 10.1016/j.jocn.2024.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 06/20/2024] [Accepted: 07/01/2024] [Indexed: 07/08/2024]
Abstract
INTRODUCTION Due to their delicate and deep-seated location, tumors in the pineal region of the brain pose exceptional challenges in neurosurgical management. Highly precise procedures have become crucial to address these complexities, such as the simultaneous performance of biopsy and endoscopic third ventriculostomy (ETV). Our aim was to assess the feasibility, safety, and efficacy of simultaneous biopsy and ETV for treating patients with pineal region tumors. METHODS Medline, Embase, and Web of Science were searched for English studies from January 2000 to February 2024, following Cochrane and PRISMA guidelines. Eligible studies encompassed a minimum of four patients and examined at least one of the following outcomes: good clinical outcomes and the necessity of shunt placement. Single proportion analysis with 95% confidence intervals was conducted under a random-effects model, employing the I2 statistic to assess heterogeneity. Additionally, publication bias was evaluated using the ROBINS-I tool. RESULTS After a meticulous selection process, eighteen studies involving 390 patients were included in the analysis. Overall, good clinical outcomes were observed in 131 out of 147 patients, representing a rate of 92 % (95 % CI: 84 % to 100 %, I2 = 62 %) through random effects analysis. Subgroup analysis showed that children exhibited a notably high rate of good clinical outcomes, reaching 100 % (95 % CI: 96 % to 100 %, I2 = 0 %). Regarding the need for shunt placement, out of the 356 patients assessed, only 39 required shunt placement, yielding a rate of 8 % (95 % CI: 4 % to 12 %, I2 = 63 %). Further sub-analyses indicated shunt requirement rates of 12 % for children and 3 % for adults. Specifically focusing on adults, data from 46 patients who underwent biopsy revealed a success rate of 84 % (95 % CI: 62 % to 100 %, I2 = 81 %). Remarkably, no major complications were reported among adults, resulting in a rate of 0 % (95 % CI: 0 % to 6 %, I2 = 0 %). Additionally, low rates of mortality related to the procedure were observed in adults, with two deaths recorded among the 46 patients analyzed, resulting in a mortality rate of 1 % (95 % CI: 0 % to 7 %, I2 = 0 %). CONCLUSION In conclusion, our study aimed to assess the feasibility, safety, and efficacy of performing simultaneous biopsy and ETV for patients with pineal region tumors. We meticulously examined clinical aspects and patient outcomes, including good clinical outcomes, the requirement for shunt placement after ETV, biopsy success rates, mortality, and complications.
Collapse
Affiliation(s)
- Marcelo Porto Sousa
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | | | | | | - Gabriel Verly
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, Cerebral Hydrodynamics Group, University of São Paulo, São Paulo, Brazil
| |
Collapse
|
2
|
Hu X, Ren YM, Yang X, Liu XD, Huang BW, Chen TY, Jv Y, Lan ZG, Liu WK, Liu XS, Hui XH, Liu JP, Zhang YK. Surgical Treatment of Pineal Region Tumors: An 18 year-Experience at a Single Institution. World Neurosurg 2023; 172:e1-e11. [PMID: 36167302 DOI: 10.1016/j.wneu.2022.09.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND The pineal tumor was once considered as a restricted area for surgery. Such cases are rare, with many different opinions on surgical treatment. This study aimed to review our experience of tumor treatment in the pineal region and explore the optimal treatment strategy. METHODS The clinical data of 72 patients with pineal tumors from January 1997 to May 2015 (18 years) were retrospectively analyzed. Preoperative preparation, pathology type, tumor resection rate, surgical approach, and follow-up outcomes were used as the indicators to evaluate the treatment efficacy. RESULTS The Krause approach was used in 46 cases, the Poppen approach in 10 cases, and the transcallosal-lateral ventricle-choroid fissure approach in 16 cases. The postoperative pathological results were as follows: 24 cases of germinoma, 11 of teratoma, 15 of glioma, 6 of meningioma, 11 of Pineocytoma, 2 of cholesteatoma, 2 of cavernous hemangioma, and 1 of choriocarcinoma. Further, the study included 64 cases of total surgical resections, 8 of subtotal resections, and 2 deaths. The follow-up period was from 7 months to 10 years. Further, 51 (70.8%) patients were followed up. The multivariate regression model showed that the surgical method and the pathological type contributed significantly to predicting outcomes. CONCLUSIONS The type of pathology, extent of excision, and surgical approach had a significant impact on the prognosis of patients. The transcallosal-lateral ventricle-choroid fissure approach for large and medium-sized pineal tumors near the posterior part of the third ventricle had good efficacy.
Collapse
Affiliation(s)
- Xing Hu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan-Ming Ren
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiang Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xiao-Dong Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Bo-Wen Huang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Teng-Yun Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Yan Jv
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Zhi-Gang Lan
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Wen-Ke Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xue-Song Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Xu-Hui Hui
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China
| | - Jing-Ping Liu
- Department of Neurosurgery, The First Xiangya Hospital, Xiangya Medical College, Central South University, Changsha, Hunan, China
| | - Yue-Kang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China.
| |
Collapse
|
3
|
Al-Dalahmah OA, Wang L, Hsiao SJ, Lin CC, Mansukhani MM, Canoll P, Bruce JN, Zanazzi G. Pineal region ganglioglioma: A neoplasm with a bimodal age distribution. Surg Neurol Int 2022; 13:245. [PMID: 35855114 PMCID: PMC9282777 DOI: 10.25259/sni_443_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022] Open
Abstract
Background:
Gangliogliomas arise very rarely in the pineal region, where their natural histories and pathologic features are poorly understood.
Case Description:
In this report, we describe a 36-year-old woman who presented with a seizure followed by worsening headache, dizziness, confusion, and intermittent left facial numbness over the next few weeks. A head CT scan showed a partially calcified pineal region mass with hydrocephalus. After an endoscopic third ventriculostomy, the patient underwent a resection of the tumor that contained dysplastic ganglion cells and piloid glial cells. Molecular profiling of this CNS WHO Grade 1 ganglioglioma revealed polysomies of chromosomes 7 and 9, and a BUB1 variant of uncertain significance, without known MAP kinase pathway alterations. From a review of the literature, we found two distinct age distributions for pineal ganglioglioma, with modes at 1 and 36 years of age.
Conclusion:
Although very rare, this tumor should be considered in the differential diagnosis of pineal region tumors in children and young adults.
Collapse
Affiliation(s)
- Osama A. Al-Dalahmah
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Linda Wang
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, United States
| | - Susan J. Hsiao
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Chun-Chieh Lin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| | - Mahesh M. Mansukhani
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Peter Canoll
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, United States
| | - Jeffrey N. Bruce
- Department of Neurosurgery, Columbia University Irving Medical Center, New York, United States
| | - George Zanazzi
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
- Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, United States
| |
Collapse
|
4
|
Kayahara T, Park Y, Tamura Y, Sasaki T. Pineal region pilocytic astrocytoma showing uncommon growth: a case report. Radiol Case Rep 2021; 16:2663-2667. [PMID: 34345327 PMCID: PMC8319481 DOI: 10.1016/j.radcr.2021.06.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 01/19/2023] Open
Abstract
Pineal region pilocytic astrocytomas are extremely rare, and there is limited information about their radiological features. We report the case of a 22-year-old woman with a cystic lesion in the pineal region. In the 2 years after diagnosis, the lesion irregularly extended along the bilateral internal cerebral veins and the inferolateral surface of the corpus callosum. Gross total resection was achieved, and the histopathological study revealed that the lesion was a pilocytic astrocytoma. The lesion exhibited uncommon growth, leading to difficulty in establishing an accurate preoperative diagnosis. It should be noted that pineal region pilocytic astrocytomas can demonstrate atypical appearances.
Collapse
Affiliation(s)
- Tomomichi Kayahara
- Department of Neurosurgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawaku, Nagoya, Aichi 454-0933, Japan,Corresponding author.
| | - Yangtae Park
- Department of Neurosurgery, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Yoji Tamura
- Department of Neurosurgery, Osaka Medical College Hospital, Takatsuki, Osaka, Japan
| | - Tomio Sasaki
- Department of Neurosurgery, Nagoya Kyoritsu Hospital, 1-172 Hokke, Nakagawaku, Nagoya, Aichi 454-0933, Japan
| |
Collapse
|
5
|
Voronina N, Aichmüller C, Kolb T, Korshunov A, Ryzhova M, Barnholtz-Sloan J, Cioffi G, Sill M, von Deimling A, Pfister SM, Gronych J, Jones DTW, Frisén J, Zapatka M, Ernst A. The age of adult pilocytic astrocytoma cells. Oncogene 2021; 40:2830-2841. [PMID: 33731860 PMCID: PMC8062266 DOI: 10.1038/s41388-021-01738-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 02/18/2021] [Accepted: 02/25/2021] [Indexed: 12/22/2022]
Abstract
Adult pilocytic astrocytomas (PAs) have been regarded as indistinguishable from pediatric PAs in terms of genome-wide expression and methylation patterns. It has been unclear whether adult PAs arise early in life and remain asymptomatic until adulthood, or whether they develop during adulthood. We sought to determine the age and origin of adult human PAs using two types of "marks" in the genomic DNA. First, we analyzed the DNA methylation patterns of adult and pediatric PAs to distinguish between PAs of different anatomic locations (n = 257 PA and control brain tissues). Second, we measured the concentration of nuclear bomb test-derived 14C in genomic DNA (n = 14 cases), which indicates the time point of the formation of human cell populations. Our data suggest that adult and pediatric PAs developing in the infratentorial brain are closely related and potentially develop from precursor cells early in life, whereas supratentorial PAs might show age and location-specific differences.
Collapse
Affiliation(s)
| | - Christian Aichmüller
- Division of Molecular Genetics, DKFZ, DKFZ-Heidelberg Center for Personalized Oncology (HIPO) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Thorsten Kolb
- Group Genome Instability in Tumors, DKFZ, Heidelberg, Germany
| | - Andrey Korshunov
- Department of Neuropathology, Heidelberg University Hospital, and CCU Neuropathology, DKFZ, Heidelberg, Germany
| | | | - Jill Barnholtz-Sloan
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Gino Cioffi
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Central Brain Tumor Registry of the United States, Hinsdale, IL, USA
| | - Martin Sill
- Hopp Children's Cancer Center Heidelberg (KiTZ); Division of Pediatric Neurooncology, DKFZ; German Cancer Consortium (DKTK), DKFZ; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas von Deimling
- Department of Neuropathology, Heidelberg University Hospital, and CCU Neuropathology, DKFZ, Heidelberg, Germany
| | - Stefan M Pfister
- Hopp Children's Cancer Center Heidelberg (KiTZ); Division of Pediatric Neurooncology, DKFZ; German Cancer Consortium (DKTK), DKFZ; Department of Pediatric Oncology, Hematology & Immunology, Heidelberg University Hospital, Heidelberg, Germany
| | - Jan Gronych
- Hopp Children's Cancer Center Heidelberg (KiTZ), Division of Pediatric Neurooncology, DKFZ; German Cancer Consortium (DKTK), DKFZ, Heidelberg, Germany.,Roche Diagnostics Deutschland GmbH, Mannheim, Germany
| | - David T W Jones
- Hopp Children's Cancer Center Heidelberg (KiTZ), Pediatric Glioma Research Group, Heidelberg, Germany
| | - Jonas Frisén
- Department of Cell and Molecular Biology, Karolinska Institute, Stockholm, Sweden
| | - Marc Zapatka
- Division of Molecular Genetics, DKFZ, DKFZ-Heidelberg Center for Personalized Oncology (HIPO) and German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Aurélie Ernst
- Group Genome Instability in Tumors, DKFZ, Heidelberg, Germany.
| |
Collapse
|
6
|
Niu X, Wang C, Zhou X, Yang Y, Liu Y, Zhang Y, Mao Q. Pineal Region Glioblastomas: Clinical Characteristics, Treatment, and Survival Outcome. World Neurosurg 2020; 146:e799-e810. [PMID: 33186787 DOI: 10.1016/j.wneu.2020.11.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/03/2020] [Accepted: 11/04/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Given the rarity of patients with pineal glioblastoma (GBM), clinical characteristics, treatment, and prognostic factors are not well characterized. This study aimed to investigate these characteristics and identify the prognostic factors of overall survival (OS). METHODS A retrospective analysis of newly diagnosed patients with pineal GBM, including our 3 cases and an additional 44 cases from published articles, was conducted. Survival analysis was performed by Kaplan-Meier analysis and Cox regression analysis was used to determine the prognostic factors. RESULTS A total of 47 patients (28 males and 19 females) were enrolled, with a median age of 46 years (range, 5-74 years). Forty-four patients (90.9%) had preoperative obstructive hydrocephalus. Among 38 patients, 21 (55.3%) had distal leptomeningeal dissemination. Forty-five patients (95.7%) had resection/biopsy, 6 of whom had gross total resection, 22 had subtotal resection, 7 had partial resection, and 10 had biopsy. Adjuvant therapy included radiotherapy in 36 patients and chemotherapy in 27 patients. The median OS was 10.0 months. The 6-month, 1-year, and 2-year survival was 68.0%, 42.6%, and 17.0%, respectively. Cox regression analysis showed that patients receiving biopsy (P = 0.042) or chemotherapy (P = 0.029) had the better OS and these were regarded as independent prognostic factors. Further survival analysis showed that chemoradiotherapy had better survival benefit than other regimens. CONCLUSIONS In this study, we summarized the characteristics of patients with pineal GBM and showed the correlation between clinical characteristics and prognosis. This study may give readers a deep understanding of these rare GBMs and provide some references for future management.
Collapse
Affiliation(s)
- Xiaodong Niu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Chenghong Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xingwang Zhou
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Yang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yanhui Liu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China
| | - Yuekang Zhang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China.
| | - Qing Mao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China; West China Glioma Centre, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
7
|
Abstract
Purpose Surgical series of pineal region gliomas are rarely available. Whereas it is a general assumption that the extent of surgical resection correlates with survival outcomes of intracranial gliomas; the impact of the microsurgical resection on the long-term outcomes of pineal gliomas has been questioned. We present a surgical series of pineal region gliomas with focus on the survival outcome analysis. Methods 17 histologically confirmed pineal region glioma patients classified as diffuse and non-diffuse gliomas were retrospectively analyzed. A detailed description of the series was followed by regression models to identify predictors of clinical outcomes. Uni- a multivariate survival analysis was performed to determine independent predictors of mortality. Results Although the number of treated patients was small, only WHO grade histopathology remained significant (p = 0.02) after multivariate survival analysis with extent of resection, age, tumor volume, and preoperative functional status. The extent of the surgical resection did not correlate with the disease survival rates of non-diffuse (p = 1), diffuse (p = 0.2), nor all gliomas (p = 0.6). 15 of 17 patients underwent gross total (nine patients) or subtotal resection. The preoperative functional status of the patients showed overall improvement on the immediate (p < 0.001) and long-term (p = 0.03) follow-up after 106 (3 – 324) months. Conclusion The extent of the surgical resection does not seem to significantly impact on the survival outcomes of pineal region gliomas. Thus, genotype and molecular features may essentially affect the outcome. Further research on the field is required. Electronic supplementary material The online version of this article (10.1007/s11060-020-03571-z) contains supplementary material, which is available to authorized users.
Collapse
|
8
|
Schulz M, Afshar-Bakshloo M, Koch A, Capper D, Driever PH, Tietze A, Grün A, Thomale UW. Management of pineal region tumors in a pediatric case series. Neurosurg Rev 2020; 44:1417-1427. [PMID: 32504201 PMCID: PMC8121748 DOI: 10.1007/s10143-020-01323-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 04/23/2020] [Accepted: 05/20/2020] [Indexed: 12/18/2022]
Abstract
Pineal region tumors commonly present with non-communicating hydrocephalus. These heterogeneous histological entities require different therapeutic regimens. We evaluated our surgical experience concerning procurance of a histological diagnosis, management of hydrocephalus, and choice of antitumoral treatment. We analyzed the efficacy of neuroendoscopic biopsy and endoscopic third ventriculocisternostomy (ETV) in patients with pineal region tumors between 2006 and 2019 in a single-center retrospective cross-sectional study with regard to diagnostic yield, hydrocephalus treatment, as well as impact on further antitumoral management. Out of 28 identified patients, 23 patients presented with untreated hydrocephalus and 25 without histological diagnosis. One patient underwent open biopsy, and 24 received a neuroendoscopic biopsy with concomitant hydrocephalus treatment if necessary. Eighteen primary ETVs, 2 secondary ETVs, and 2 ventriculoperitoneal shunts (VPSs) were performed. Endoscopic biopsy had a diagnostic yield of 95.8% (23/24) and complication rates of 12.5% (transient) and 4.2% (permanent), respectively. ETV for hydrocephalus management was successful in 89.5% (17/19) with a median follow-up of more than 3 years. Following histological diagnosis, 8 patients (28.6%) underwent primary resection of their tumor. Another 9 patients underwent later-stage resection after either adjuvant treatment (n = 5) or for progressive disease during observation (n = 4). Eventually, 20 patients received adjuvant treatment and 7 were observed after primary management. One patient was lost to follow-up. Heterogeneity of pineal region tumor requires histological confirmation. Primary biopsy of pineal lesions should precede surgical resection since less than a third of patients needed primary surgical resection according to the German pediatric brain tumor protocols. Interdisciplinary decision making upfront any treatment is warranted in order to adequately guide treatment.
Collapse
Affiliation(s)
- Matthias Schulz
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Melissa Afshar-Bakshloo
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Arend Koch
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - David Capper
- Department of Neuropathology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Pablo Hernáiz Driever
- Department of Pediatric Oncology and Hematology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna Tietze
- Institute of Neuroradiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Arne Grün
- Department of Radiation Oncology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ulrich-Wilhelm Thomale
- Pediatric Neurosurgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
| |
Collapse
|
9
|
Choque-Velasquez J, Resendiz-Nieves J, Jahromi BR, Colasanti R, Raj R, Vehviläinen J, Tynninen O, Collan J, Niemelä M, Hernesniemi J. Extent of Resection and Long-Term Survival of Pineal Region Tumors in Helsinki Neurosurgery. World Neurosurg 2019; 131:e379-e391. [PMID: 31369883 DOI: 10.1016/j.wneu.2019.07.169] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/22/2019] [Accepted: 07/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pineal region tumors represent challenging surgical lesions with wide ranges of survival reported in different surgical series. In this article, we emphasize the role of complete microsurgical resection (CMR) to obtain a favorable long-term outcome of pineal region tumors. METHODS We report a retrospective study of pineal region tumors operated on in Helsinki Neurosurgery between 1997 and 2015. Information was obtained from the hospital records, and an evaluation of the Finnish population register was conducted in July 2018 to determine the current status of the patients. RESULTS A total of 76 pineal region tumors were operated on. The survival was 62% at a mean follow-up of 125 ± 105 months (range, 0-588 months), and the disease-related mortality was limited to 14 patients (18.4%). Up to July 2018, 29 patients had died. Two patients died 1 and 3 months after surgery of delayed thalamic infarctions, 12 patients of disease progression, and 15 had non-disease-related deaths. Only 1 patient was lost in the long-term follow-up. Ten of 14 disease-related deaths occurred during the first 5 years of follow-up: 5 diffuse gliomas, 3 germ cell tumors, 1 grade II-III pineal parenchymal tumor of intermediate differentiation, and 1 meningioma. CMR was linked to better tumor-free survival and long-term survival, with the exception of diffuse gliomas. CONCLUSIONS CMR, in the setting of a multidisciplinary management of pineal region tumors, correlates with favorable survival and with minimal mortality. Surgically treated grade II-IV gliomas constitute a particular group with high mortality within the first 5 years independently of the microsurgical resection.
Collapse
Affiliation(s)
- Joham Choque-Velasquez
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Julio Resendiz-Nieves
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Behnam Rezai Jahromi
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Roberto Colasanti
- Department of Neurosurgery, Umberto I General Hospital, Università Politecnica delle Marche, Ancona, Italy; Department of Neurosurgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juho Vehviläinen
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Olli Tynninen
- Department of Pathology, University of Helsinki and HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - Juhani Collan
- Department of Radiation Oncology, Cancer Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juha Hernesniemi
- "Juha Hernesniemi" International Center for Neurosurgery, Henan Provincial Peopleás Hospital, Zhengzhou, China
| |
Collapse
|
10
|
Li D, Wen R, Gao Y, Xu Y, Xiong B, Gong F, Wang W. Pineal Region Gliomas: A Single-Center Experience with 25 Cases. World Neurosurg 2019; 133:e6-e17. [PMID: 31284062 DOI: 10.1016/j.wneu.2019.06.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pineal region glioma is a rare systematically reported tumor in the literatures, and little is known about its behavior, development, and best treatment strategies because of its complex anatomical relationship and rarity. OBJECTIVE We reviewed the outcomes of patients with pineal region gliomas in West China hospital in the past 5 years and searched the literature to add more information. As a result, key factors related to prognosis are identified. METHODS Twenty-five patients with pineal region gliomas were selected and information was collected about detailed medical history, imaging data, treatment methods, pathologic results, and latest neurosurgical radiologic progress during follow-up. RESULTS Pilocytic astrocytomas (20%) and glioblastomas (24%) were the most common pathologic subtypes. Twenty-three patients underwent open surgery, 3 Gamma Knife radiosurgery, and 4 whole-brain radiation therapy. Chemotherapy was applied to 3 patients. Low-grade gliomas tended to have a better prognosis than did high-grade. Karnofsky Performance Status at admission (≤60) was intimately associated with prognosis for low-grade gliomas. As for high-grade gliomas, patients whose age at admission was ≤30 years had a better prognosis than did older patients (>30 years). However, whatever the grade, there was no overall survival difference as to gender, gross total resection versus not gross total resection, preoperative maximal tumor diameter (≤4 vs. >4 cm), and time since first symptoms (≤30 vs. >30 days), and radiation therapy versus no radiation therapy. CONCLUSIONS Open surgery is the first-line strategy for pineal region gliomas with tolerable mortality and disability rate. Radiosurgery and chemotherapy can be applied as adjuvant or alternative methods when surgery is contraindicated.
Collapse
Affiliation(s)
- Denghui Li
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Rong Wen
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Yuan Gao
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Yangyang Xu
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Botao Xiong
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Feilong Gong
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China
| | - Wei Wang
- Neurosurgery Department of West China Hospital Affiliated to Sichuan University, Wuhou District, Chengdu, Sichuan Province, People's Republic of China.
| |
Collapse
|
11
|
Granados AM, Ospina C, Paredes S. Pineal gliosarcoma in a 5-year-old girl. Radiol Case Rep 2017; 13:244-247. [PMID: 29487662 PMCID: PMC5826464 DOI: 10.1016/j.radcr.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/06/2017] [Accepted: 11/06/2017] [Indexed: 11/24/2022] Open
Abstract
The purpose of this paper is to report a rare case of a pediatric pineal gliosarcoma. Gliomas on the pineal region are uncommon, representing 0.4%-1% of all brain tumors. Furthermore, pediatric gliosarcomas are a very rare entity. We present a case of a 5-year-old girl, with a history of headache, vomiting, diplopia, and gait disturbances. A pineal tumor was found with pathology results consistent with a gliosarcoma. A total of 25 cases of pediatric gliosarcomas have been reported, none of them in pineal topography. Only 3 gliosarcomas were found in the pineal region, but these were found in adults. To our knowledge, this is the first pediatric pineal gliosarcoma reported in the literature.
Collapse
Affiliation(s)
- Ana María Granados
- Department of Diagnostic Imaging, Fundación Valle del Lili, Cali, Colombia
| | - Camila Ospina
- Center of Clinical Research, Fundación Valle del Lili, Cali, Colombia
| | - Stephania Paredes
- ICESI University, Fundación Valle del Lili, Carrera 98 # 18-49, Cali, 760001, Colombia
| |
Collapse
|
12
|
Lim SH, Lee ES, Choi JY, Kim JS. Isolated Trochlear Palsy Due to Pilocytic Astrocytoma Involving the Pineal Gland. J Clin Neurol 2017; 13:429-431. [PMID: 28831788 PMCID: PMC5653634 DOI: 10.3988/jcn.2017.13.4.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/20/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Sung Hwan Lim
- Department of Neurology, Hanyang University College of Medicine, Hanyang University Guri Hospital, Guri, Korea
| | - Eek Sung Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
| |
Collapse
|
13
|
Nadvi SS, Timatkia K. Primary pineal glioblastoma multiforme mimicking a germ cell tumour. Br J Neurosurg 2016; 32:456-457. [DOI: 10.1080/02688697.2016.1265084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Syed Sameer Nadvi
- Department of Neurosurgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- St Augustine’s Hospital, Durban, South Africa
| | - Kritish Timatkia
- Department of Neurosurgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
14
|
Felbaum D, Syed HR, Ryan JE, Jean WC, Anaizi A. Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note. Cureus 2016; 8:e520. [PMID: 27081581 PMCID: PMC4829397 DOI: 10.7759/cureus.520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal resection of a traditionally difficult pineal region tumor. Further experience with this combined technique may allow for improved surgical outcomes for these complex lesions.
Collapse
Affiliation(s)
| | - Hasan R Syed
- Neurosurgery, Medstar Georgetown University Hospital
| | - Joshua E Ryan
- Neurosurgery, Medstar Georgetown University Hospital
| | - Walter C Jean
- Neurosurgery, Medstar Georgetown University Hospital
| | - Amjad Anaizi
- Neurosurgery, Medstar Georgetown University Hospital
| |
Collapse
|
15
|
Sugita Y, Terasaki M, Tanigawa K, Ohshima K, Morioka M, Higaki K, Nakagawa S, Shimokawa S, Nakashima S. Gliosarcomas arising from the pineal gland region: uncommon localization and rare tumors. Neuropathology 2015; 36:56-63. [DOI: 10.1111/neup.12226] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 05/22/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Yasuo Sugita
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Mizuhiko Terasaki
- Departments of Neurosurgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Ken Tanigawa
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Koichi Ohshima
- Departments of Pathology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Motohiro Morioka
- Departments of Neurosurgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Koichi Higaki
- Department of Pathology, St. Mary's Hospital; Kurume Japan
| | | | - Shoko Shimokawa
- Department of Neurosurgery, St. Mary's Hospital; Kurume Japan
| | | |
Collapse
|