title: Upfront Stereotactic Radiosurgery for Pineal Parenchymal Tumors in Adults.
abstract: OBJECTIVE
  Pineal parenchymal tumors (PPTs) in adults are rare, and knowledge regarding their optimal management and treatment outcome is limited. Herein, we present the clinical results of our series of PPTs other than pineoblastomas managed by stereotactic radiosurgery (SRS) at upfront setting.
  
  
  METHODS
  Between 1997 and 2014, nine consecutive adult patients with the diagnosis of PPTs, either pineocytoma or pineal parenchymal tumor of intermediate differentiation, were treated with SRS. There were 6 men and 3 women. The median age was 39 years (range, 31-53 years). All of the patients presented with symptoms of hydrocephalus. Endoscopic third ventriculostomy and biopsy was done for initial management. After histologic diagnosis, patients were treated with Gamma Knife with the mean dose of 13.3 Gy (n=3) or fractionated Cyberknife with 32 Gy (n=6).
  
  
  RESULTS
  After a mean follow-up of 78.6 months (range, 14-223 months), all patients were alive and all of their tumors were locally controlled except for one instance of cerebrospinal fluid seeding metastasis. On magnetic resonance images, tumor size decreased in all patients, resulting in complete response in 3 patients and partial response in 6. One patient had experienced temporary memory impairment after SRS, which improved spontaneously.
  
  
  CONCLUSIONS
  SRS is effective and safe for PPTs in adults and can be considered as a useful alternative to surgical resection at upfront setting.
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jong Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Jeong Hoon
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Do Hoon
authors.initials: DH
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Chang Jin
authors.initials: CJ
authors.lastname: Kim
authors.affiliation: Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Shin Kwang
authors.initials: SK
authors.lastname: Khang
authors.affiliation: Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Hyun
authors.initials: YH
authors.lastname: Cho
keywords: Pineal parenchymal tumor; Pineal parenchymal tumors of intermediate differentiation; Pineocytoma; Stereotactic radiosurgery