title: Intraosseous Metastasizing of Pineoblastoma into the Anterior Skull Base, Calvarial Bones, and Vertebrae.
abstract: Pineoblastoma is a rare malignant tumor of the central nervous system (CNS), which arises from the parenchyma of the pineal gland. It is characterized by aggressive clinical behavior and frequent metastases along the craniospinal axis. Extraneural metastases may occur due to surgical seeding of tumor cells beyond the dura and/or hematogenous spread, ventriculoperitoneal shunting, or through Batson's plexus. To our knowledge, only six documented cases of intraosseous metastases of pineoblastoma are described in the literature. A 23-year-old female patient presented with clinical and radiological symptoms of a pineal tumor causing secondary hydrocephalus. After initial surgical treatment, chemotherapy, and local radiotherapy with craniospinal irradiation, she developed multiple metastases affecting the anterior skull base, intracranial meninges, frontal bone, and finally, the entire vertebral column. The patient received surgical treatment for the anterior skull base metastasis, repeated irradiation of the neuraxis, radiosurgical and radiotherapeutic procedures, and chemotherapy. The patient survived 57 months after the primary disease manifestation and died of multiple metastases. This presented case is the first known description of metastasis of pineoblastoma in the anterior cranial base. Multiple intracranial metastases were suppressed using CyberKnife radiation treatment and chemotherapy until massive involvement of spinal column occurred. Interestingly, no signs of brain radiation necrosis after repeated radiation treatments were observed, and the patient developed only moderate neurocognitive decline.
authors: Skull Base and Craniofacial Surgery, Burdenko Neurosurgery Institute.
authors: Denis
authors: D
authors: Golbin
authors: Department of Radiation Oncology, Burdenko Neurosurgery Institute.
authors: Konstantin V
authors: KV
authors: Nikitin
authors: Burdenko Neurosurgery Institute.
authors: Alexander N
authors: AN
authors: Konovalov
authors: Neurooncology, Burdenko Neurosurgery Institute.
authors: David I
authors: DI
authors: Pitskhelauri
authors: Neuropathology, Burdenko Neurosurgery Institute.
authors: Liudmila V
authors: LV
authors: Shishkina
authors: Department of Radiation Oncology, Burdenko Neurosurgery Institute.
authors: Andrey V
authors: AV
authors: Golanov
authors: Burdenko Neurosurgery Institute.
authors: Vasily A
authors: VA
authors: Cherekaev
authors: Neurooncology, Burdenko Neurosurgery Institute.
authors: Grigory L
authors: GL
authors: Kobiakov
authors: Neurooncology, Burdenko Neurosurgery Institute.
authors: Oksana V
authors: OV
authors: Absalyamova
authors: Neurooncology, Burdenko Neurosurgery Institute.
authors: Nikolay
authors: N
authors: Lasunin
authors: Department of Radiation Oncology, Burdenko Neurosurgery Institute.
authors: Natalia
authors: N
authors: Antipina
keywords: hypofractionated radiotherapy; osseous metastasis; pineoblastoma; stereotactic radiosurgery; stereotactic radiotherapy