title: Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment.
abstract: The aim of the study is to identify characteristic features of pineal germinoma that enhance preoperative accuracy in differentiating germinoma from other pineal region tumors. Twenty-one consecutive patients with pineal region tumors were enrolled. In all patients, tumor resection was performed to verify the histology. Clinical records including upward gaze palsy of Parinaud's syndrome and neuroimaging were analyzed. In addition, we evaluated the relationship between magnetic resonance imaging (MRI) findings and tumor progression patterns in pineal germinoma. Among 21 patients, 15 patients were diagnosed with germ cell tumor, 4 with pineal parenchymal cell tumor, and 2 with meningioma. Upward gaze palsy was seen in 11 patients; nine had pure germinomas and two had mixed germ cell tumors. These tumors occupied the pineal region with extension to the area of the mesodiencephalic junction (MDJ) and the bi-epithalamic area between the bilateral pulvinar and the third ventricle. Tumor involvement of the former area could cause upward gaze palsy by insulting the rostral interstitial nucleus of the medial longitudinal fasciculus located in the MDJ area. Tumor invasion into the latter area is commonly seen as a cardioid-shaped tumor as the tumor image on the axial MRI view. Upward gaze palsy and a cardioid-shaped tumor image on the axial MRI views were demonstrated to be specific features of pineal pure germinoma. It is suggested that combination of both features may become useful tools to preoperatively differentiate germinoma from other pineal tumors, resulting in achievement of the optimum treatment of pineal region tumors.
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. iakihiro3@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Washoukai Sadamoto Hospital, 1-6-1 Takehara, Matsuyama, Ehime, 790-0052, Japan.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ohnishi
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Shohei
authors.initials: S
authors.lastname: Kohno
authors.affiliation: Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ohue
authors.affiliation: Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Iwata
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Shirabe
authors.initials: S
authors.lastname: Matsumoto
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Nishikawa
authors.affiliation: Department of Neurosurgery, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, Ehime, 790-0024, Japan.
authors.forename: Saya
authors.initials: S
authors.lastname: Ozaki
authors.affiliation: Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Riko
authors.initials: R
authors.lastname: Kitazawa
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan.
authors.forename: Takeharu
authors.initials: T
authors.lastname: Kunieda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D002648:Child; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D018237:Germinoma / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D010870:Pineal Gland; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Germinoma; Magnetic resonance imaging; Parinaud’s syndrome; Pineal region tumors; Rostral interstitial nucleus of the medial longitudinal fasciculus; Upward gaze palsy