title: [Analysis of the surgical strategy for the treatment of pineal region tumors].
abstract: OBJECTIVE
  To evaluate and explore the optimal surgical strategy for the normalized treatment of pineal region tumors.
  
  
  METHODS
  From September 2007 to February 2012, 43 patients were treated in Chinese People's Liberation Army General Hospital, including 30 male and 14 female patients, with pineal region tumors and non-communicating hydrocephalus were enrolled, who were 1-52 years old, mean age was (27 ± 4) years. The clinical records, treatment strategy, and prognosis were retrospectively analyzed. All the patients routinely underwent endoscopic third ventriculostomy (ETV) and tumor biopsy as the initial treatment. Twenty-seven cases (62.8%, pure endoscopic group) with histological diagnosis of germinoma (23 cases) or pineoblastoma (4 cases) were treated with chemotherapy with/without radiation therapy after ETV. The rest 16 cases (37.2%, craniotomy group) with histological diagnosis of non-germinoma and non-pineoblastoma (5 astrocytomas, 4 pineocytomas, 4 teratomas, 2 ependymomas, and 1 pineopappiloma) had craniotomy and tumor resection after ETV. All the cases had routine follow-up at 1, 3, and 6 months after the final surgery. The clinical, imaging, and tumor markers analysis were routinely examined at follow-up.
  
  
  RESULTS
  In the pure endoscopic group, 1 case had intra-ventricular hemorrhage after ETV, followed by external ventricular drainage and recovered after 1 week. Endoscopic procedure related short-term ( < 3 months) complication rate was 2.3% (1/43), while long-term morbidity was 0. All cases in the pure endoscopic group had chemotherapy with/without radiation therapy. Long-term follow-up results showed that all cases were cured or had progression free survival (PFS). In the craniotomy group, 2 cases (2/16) developed intra-cranial hemorrhage after surgery, and had to be operated again for hematoma evacuation. In the craniotomy group, the short-term ( < 3 months) morbidity rate was 6/16. At 3 months follow-up, 1 case still had homonymous hemianopia, which made the long-term morbidity rate was 1/16.
  
  
  CONCLUSIONS
  For pineal region tumors with non-communicating hydrocephalus, simultaneous ETV with tumor biopsy can be the most favorable initial diagnostic and therapeutic treatment. Second-stage treatment (chemotherapy, radiation therapy, or craniotomy with tumor resection) can be selected according to the histological diagnosis.
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Guoqiang
authors.initials: G
authors.lastname: Xie
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China. Email: chxlei@mail.sysu.edu.cn.
authors.forename: Xiaolei
authors.initials: X
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Jiashu
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Fangye
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Guochen
authors.initials: G
authors.lastname: Sun
authors.affiliation: Department of Neurosurgery, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
authors.forename: Xinguang
authors.initials: X
authors.lastname: Yu
mesh_terms: D000293:Adolescent; D000328:Adult; D001932:Brain Neoplasms / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006849:Hydrocephalus / Q000473:pathology; D007223:Infant; D008297:Male; D008875:Middle Aged; D010870:Pineal Gland; D010871:Pinealoma / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D014696:Ventriculostomy; D055815:Young Adult