Microsurgical management of pineal region lesions: personal experience with 119 patients.
BACKGROUND
Lesions of the pineal region are histopathologically heterogeneous but often accompanied with severe progression of clinical signs. Surgical treatment remains challenging because of the close vicinity of the deep venous system and the mesencephalo-diencephalic structures in this region. We present the surgical approaches and techniques in a consecutive series of 119 patients treated by the senior author (J.H.) between 1980 and 2007 at 2 different neurosurgical university centers in Kuopio and Helsinki, Finland.


METHODS
Of the included patients, 107 (90%) presented with pineal region tumors and 12 (10%) with vascular malformations. The ITSC route was used for removal of the lesion in 111 (93%) patients and the OIH approach in 8 (7%) patients. All except one patient were operated on in a sitting position.


RESULTS
We reviewed all clinical data and radiographic images and analyzed all surgical videos. The pineal lesions were removed completely in most cases (88%). There was no surgical mortality. Twenty-two (18%) of the patients had complications in the postoperative period; these included 1 epidural hematoma, 9 transient Parinaud syndrome, 2 meningitis, 3 wound infections, 2 transient memory disturbances, 2 mild hemiparesis, 1 CSF fistula, and 2 cranial nerves palsies (IV and VI). During a 3.5-year follow-up, 12 patients with malignant lesions died; all patients with benign tumors survived.


CONCLUSIONS
The ITSC route is a safe and effective surgical approach, associated with low morbidity, complete lesion removal, and definitive histopathologic diagnosis. Considering risk vs benefit, we therefore believe that the surgical treatment can be offered in most cases as the first treatment option for pineal tumors.
Hernesniemi
Juha
J
Department of Neurosurgery, Helsinki University Central Hospital, 00260 Helsinki, Finland. juha.hernesniemi@hus.fi
Romani
Rossana
R
Albayrak
Baki S
BS
Lehto
Hanna
H
Dashti
Reza
R
Ramsey
Christian
C
Karatas
Ayse
A
Cardia
Andrea
A
Navratil
Ondrej
O
Piippo
Anna
A
Fujiki
Minoru
M
Toninelli
Stefano
S
Niemelä
Mika
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D005387:Finland; D006801:Humans; D007223:Infant; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D010870:Pineal Gland; D011183:Postoperative Complications; D011187:Posture; D012189:Retrospective Studies