title: [Surgical approaches to pineal region - review article].
abstract: The pineal region is a deep-seated part of the brain surrounded by highly eloquent structures. Differential diagnosis of space-occupying lesions in this region encompasses pineal gland cysts, pineal gland tumours, metastases, germ cell tumours, meningiomas, gliomas, hemangioblastomas and neuroectodermal tumours. A treatment strategy is based mainly on tumour anatomical characteristics and histological type. Except germinatous tumours, a surgical excision is the treatment of choice.
  
  
  
  Microsurgical approaches: The microsurgical supracerebellar-infratentorial approach is an essential approach to the pineal region. Despite certain risks, it allows a straightforward and completely extracerebral approach with a minimal cerebellar retraction. The other basic approach is the microsurgical occipital-transtentorial approach that is advantageous in patients with a supratentorial tumour extension or a steep tentorium. The interhemispheric-transcallosal approach and the transcortical-transventricular approach are possible options in selected cases.Endoscopic approaches: The neuroendoscopy provides a minimally invasive method to perform a tumour biopsy and to treat hydrocephalus in one session. Stereotactic biopsy: The stereotactic needle biopsy represents an alternative to the endoscopic biopsy in patients without hydrocephalus and in patients with dorsally located lesions inaccessible from the third ventricle.
  
  
  
  Modern neurosurgery offers a rich variety of surgical approaches to the pineal region. The complexity of space-occupying lesions in this region requires an individualised treatment, a prudent preoperative planning and a meticulous surgical technique.
authors.forename: M
authors.initials: M
authors.lastname: Májovský
authors.forename: D
authors.initials: D
authors.lastname: Netuka
authors.forename: V
authors.initials: V
authors.lastname: Beneš
mesh_terms: D006801:Humans; D001706:Biopsy / Q000379:methods; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D003937:Diagnosis, Differential; D008866:Microsurgery / Q000379:methods; D044583:Neuroendoscopy / Q000379:methods; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods; D010347:Patient Care Planning; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery; D010871:Pinealoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D020379:Risk Adjustment; D013238:Stereotaxic Techniques
keywords: pineal gland pineal tumours neurosurgical procedures - craniotomy neuroendoscopy.