Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study

2000 ◽  
Vol 93 (2) ◽  
pp. 245-253 ◽  
Author(s):  
Shizuo Oi ◽  
Masayoshi Shibata ◽  
Jiro Tominaga ◽  
Yumie Honda ◽  
Masaki Shinoda ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Prospective Study ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Therapeutic Outcomes ◽  
Tumor Dissemination ◽  
Tumor Debulking ◽  
Fine Print

Object. This prospective study is based on a consecutive series of 20 patients with pineal region tumors who underwent minimally invasive preferential management. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors.Methods. If the tumor markers α-fetoprotein and human chorionic gonadotropin were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy.Subsequent procedures were determined on the basis of verified individual tumors. For treatment of germinomas and pineoblastomas, if no tumor dissemination was confirmed by pre-, intra-, or postoperative findings, stereotactic radiotherapy or radiosurgery was performed after one course of chemotherapy with the ICE regimen (isofomid, cisplatin, and etoposide) and followed by two additional courses of chemotherapy. For treatment of malignant germ cell tumors, after extensive surgery, adjuvant chemotherapy with the ICE regimen was performed in three courses in all cases. Then radiotherapy was started using various methods, depending on the evidence of tumor dissemination. For treatment of teratomatous and neuroectodermal tumors other than pineoblastomas, extensive surgical removal was performed. As for adjuvant therapy, if the tumor was a low-grade glioma or if the patient was younger than 5 years of age, postoperative treatment did not include radiotherapy. If the tumor was a malignant teratoma or high-grade glioma, conventional focal radiotherapy was performed, followed by chemotherapy with ICE for 1 year.All but two treated patients had ventriculomegaly. Neuroendoscopic procedures were performed in six of 15 treated patients. Neuroendoscopic biopsy with tumor debulking offered enough material for tissue diagnosis, including immunohistochemical analysis and, in one case, revealed evidence of tumor dissemination undetectable on neuroimaging. With one exception, no shunt was required in any patient undergoing endoscopic third ventriculostomy. Stereotactic radiotherapy was performed in indicated cases. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 24 months to 6.5 years.Conclusions. Our minimally invasive preferential regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and radiotherapy and promising excellent therapeutic outcomes. The treatment for malignant pineal region tumors remains a subject for further study.

Tuberculoma mimicking a pinealoma

1983 ◽  
Vol 59 (5) ◽  
pp. 875-878 ◽  
Author(s):  
Ian R. Whittle ◽  
John L. Allsop ◽  
Michael Besser
Keyword(s):  
Obstructive Hydrocephalus ◽  
Pineal Region ◽  
Subtotal Resection ◽  
Third Ventriculostomy ◽  
Antituberculous Therapy ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Serial Ct ◽  
Cerebral Tuberculoma ◽  
Fine Print

✓ Computerized tomography (CT) revealed obstructive hydrocephalus and a pineal mass in a 14-year-old girl who presented with headaches and a Parinaud's syndrome. Although there was no major evidence of extracranial tuberculosis, and cerebrospinal fluid obtained during third ventriculostomy contained no leukocytes, suboccipital transtentorial biopsy of the lesion revealed it to be a tuberculoma. Serial CT scans showed resolution of the lesion following subtotal resection and antituberculous therapy. The implications of this case with regard to difficulties in the diagnosis of cerebral tuberculoma and the management of pineal region tumors are discussed.

Diagnosis and management of pineal tumors

1983 ◽  
Vol 58 (5) ◽  
pp. 654-665 ◽  
Author(s):  
Rashid Jooma ◽  
Brian E. Kendall
Keyword(s):  
Tumor Markers ◽  
Germ Cell Tumors ◽  
Ct Scanning ◽  
Individual Case ◽  
Pineal Region ◽  
Pineal Tumors ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Primary Surgery ◽  
Fine Print

✓ The management of pineal region tumors remains controversial. Advocates of a conservative approach emphasize the excellent results of radiotherapy, particularly with germinomas, while a number of recent reports have demonstrated the safety of direct surgery. In order to improve treatment planning, attempts have been made to distinguish the various tumor types by computerized tomography (CT) and by the use of markers for germ-cell tumors. This paper reports a study of 35 patients with pineal tumors including two ectopic germinomas. Pretreatment CT was performed in all 35 patients, and human chorionic gonadotropin and alpha-fetoprotein levels were assayed in 11. Histological verification was available for 33 tumors; the other two were characterized by clinical and CT features plus tumor markers. Of the 27 tumor operations, 21 were for a pineal mass and six for ectopic germinoma or metastasis. There was no operative mortality. Morbidity was minimal, and surgery did not increase the incidence of subarachnoid seeding. Each histological type of tumor has a typical appearance on CT scanning, although, in the individual case, a firm diagnosis is not always possible. However, consideration of CT scans together with the clinical features, cerebrospinal fluid cytology, tumor markers, and (if there is still doubt) response to a small dose of irradiation will generally allow a specific diagnosis with a high degree of probability. In this way, germinomas may be selected for radiotherapy and the tumors less likely to respond may be subjected to primary surgery.

Pineal region tumors in children

1988 ◽  
Vol 68 (5) ◽  
pp. 689-697 ◽  
Author(s):  
Michael S. B. Edwards ◽  
Roger J. Hudgins ◽  
Charles B. Wilson ◽  
Victor A. Levin ◽  
William M. Wara
Keyword(s):  
Radiation Therapy ◽  
Magnetic Resonance ◽  
Tumor Markers ◽  
Poor Prognosis ◽  
Pineal Region ◽  
Recurrent Tumor ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Tumor Types ◽  
Fine Print

✓ The authors believe that the preferred treatment for pineal region tumors in children requires definitive surgery with a histological diagnosis and that a conservative approach consisting of shunting and radiation therapy no longer seems to be appropriate. The results are reported of a retrospective review of the presentation, treatment, and outcome of 36 children under the age of 18 years treated between 1974 and 1986. Eleven children had germinomas (two-cell type), seven had astrocytomas, and the remaining 18 had 15 histologically different tumor types. Surgery was performed on 30 patients; there were no deaths, but a 10% rate of persistent morbidity was found. The median follow-up period was 4 years. Nine (82%) of 11 patients with germinomas are alive without evidence of recurrence; one child died from recurrent tumor in the pineal region and another is presently being treated for recurrent tumor of the spinal cord. Six (86%) of the seven patients with astrocytoma are well after biopsy and radiation therapy. Of the remaining 18 children, five (28%) died from tumor progression. The cerebrospinal fluid (CSF) tumor markers α-fetoprotein and β-human chorionic gonadotropin were helpful in determining the presence of malignant germ-cell tumors, particularly those with a poor prognosis. Magnetic resonance imaging was useful for diagnosis and for planning the operative approach. Magnetic resonance images showed the presence of pineal region tumors in four children with hydrocephalus who had no evidence of tumor on computerized tomography scans. Because the great variety of tumor types found in the pineal region must be treated in different ways and because improved microsurgical and stereotaxic surgical techniques have made mortality and morbidity rates acceptably low, a biopsy diagnosis should be obtained in all patients. Preoperative assessment of CSF tumor markers and cytology is useful for the identification of patients who have a poor prognosis.

scholarly journals The Role of Neuroendoscopy in the Treatment of Pineal Region Tumors

2018 ◽  
Vol 22 (2) ◽  
pp. 21-25
Author(s):  
Flávio Ramalho Romero ◽  
Eduardo De Freitas Bertolini ◽  
Adalberto Sestari ◽  
Sérgio Soares Guerrero ◽  
Ramon Barbalha Guerrero ◽  
...  
Keyword(s):  
Diagnostic Yield ◽  
Pineal Region ◽  
Endoscopic Biopsy ◽  
Third Ventriculostomy ◽  
Tumor Biopsy ◽  
Pineal Tumors ◽  
Pineal Region Tumors ◽  
Therapeutic Outcomes ◽  
Initial Procedure

Object. The authors report their experience in six patients presenting with pineal tumors and associated hydrocephalus who underwent an endoscopic biopsy procedure and third ventriculostomy (ETV) in a single setting. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors. Methods. A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was ndertaken. Neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy. Subsequent procedures were determined on the basis of verified individual tumors. Results. Over a 2-year interval, 6 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 54 years of age (mean 24.3 years). All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield of the biopsy was 100%. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 6 to 24 months. Conclusion. The majority of our patients with dilated ventricles were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and promising excellent therapeutic outcomes.

Combined supra/infratentorial—transsinus approach to large pineal region tumors

1998 ◽  
Vol 88 (6) ◽  
pp. 1050-1057 ◽  
Author(s):  
Ibrahim M. Ziyal ◽  
Laligam N. Sekhar ◽  
Eduardo Salas ◽  
Wayne J. Olan
Keyword(s):  
Venous Pressure ◽  
Tumor Resection ◽  
Occipital Lobe ◽  
Transverse Sinus ◽  
Pineal Region ◽  
Combined Approach ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Fine Print

Object. The authors sought to confirm that the combined supra/infratentorial—transsinus approach offers a safer means of resecting large pineal region tumors than other approaches currently being used. The aforementioned method provides a wider exposure of the pineal region with less brain retraction than the infratentorial—supracerebellar or the occipital—transtentorial approach alone and is applicable to some large and giant tumors of this area. This combined approach was used in six patients to remove large pineal region tumors including four tentorial meningiomas, one pineocytoma, and one epidermoid cyst. Methods. The transverse sinus and tentorium were sectioned after review of preoperative angiographic studies, after taking intraoperative measurements of the venous pressure in the nondominant transverse sinus before and after clipping and while monitoring the somatosensory evoked potentials. The occipital lobe cortex and cerebellum were retracted slightly along the tentorium. Deep veins of the galenic system, the quadrigeminal area, and the tumor were well exposed. Before it was used for tumor resection the approach was studied in five cadaveric head specimens, and the projection of different approaches was compared radiologically. The tumors were removed in a gross-total manner in all patients, and none of the major veins of the galenic system was injured. Resuturing of the nondominant transverse sinus was performed postoperatively in one patient. One of the six patients experienced transient visual loss, and another suffered mild right sixth cranial nerve paresis; however, both recovered in 3 weeks. The wide exposure of the combined approach was also confirmed on radiological and anatomical studies. Conclusions. The combined supra/infratentorial—transsinus approach is preferred for the resection of certain large pineal region tumors.

Ultrasound-guided biopsy for deep-seated brain tumors

1982 ◽  
Vol 57 (2) ◽  
pp. 164-167 ◽  
Author(s):  
Yutaka Tsutsumi ◽  
Yukihiko Andoh ◽  
Norio Inoue
Keyword(s):  
Pituitary Adenoma ◽  
Brain Tumors ◽  
Real Time ◽  
Pineal Region ◽  
Ultrasound Guided ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Biopsy Technique ◽  
Ultrasonic Apparatus ◽  
Fine Print

✓ An easy, accurate, and safe biopsy technique for deep-seated brain tumors using a newly devised real-time ultrasonic apparatus is presented. Three lesions, one large pituitary adenoma and two pineal region tumors, were biopsied successfully by this technique.

Safety of transforaminal lumbar interbody fusion and intervertebral recombinant human bone morphogenetic protein—2

2005 ◽  
Vol 3 (6) ◽  
pp. 436-443 ◽  
Author(s):  
Alan T. Villavicencio ◽  
Sigita Burneikiene ◽  
E. Lee Nelson ◽  
Ketan R. Bulsara ◽  
Mark Favors ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Interbody Fusion ◽  
Transforaminal Lumbar Interbody Fusion ◽  
Bone Morphogenetic Protein 2 ◽  
Content Type ◽  
Morphogenetic Protein ◽  
Human Bone Morphogenetic Protein ◽  
Recombinant Human Bone ◽  
Fine Print

Object. Recombinant human bone morphogenetic protein—2 (rhBMP-2) is being increasingly used for spinal fusion. There are few data regarding its clinical safety, effectiveness, and clinical outcome when applied on an absorbable collagen sponge (ACS) in conjunction with allograft for transforaminal lumbar interbody fusion (TLIF). Methods. Seventy-four consecutive patients undergoing TLIF for degenerative disc disease were divided into five groups depending on whether the patient underwent a minimally invasive or open approach, as well as the number of spinal levels surgically treated. Surgery-related data, fusion results, complications, and clinical outcome were evaluated. The mean follow-up duration was 20.6 months (range 14–28 months). The radiographic fusion rate was 100% at 12 and 24 months after the surgery. No bone overgrowth or other complications related to BMP use were demonstrated. Conclusions. Analysis of the results demonstrated that TLIF combined with a BMP-2—soaked ACS is a feasible, effective, and safe method to promote lumbar fusion. There were no significant intergroup differences in clinical outcome between patients who underwent open compared with minimally invasive procedures. Patient satisfaction rates, however, were higher in the minimally invasive procedure group. The efficacy of BMP-2 was not dependent on which approach was used or the number of spinal levels that were treated.

Minimally invasive implantation of epidural spinal cord neurostimulator electrodes by using a tubular retractor system

2004 ◽  
Vol 100 (6) ◽  
pp. 1119-1121 ◽  
Author(s):  
Matthew R. Johnson ◽  
Daniel J. Tomes ◽  
John S. Treves ◽  
Lyal G. Leibrock
Keyword(s):  
Spinal Cord ◽  
Postoperative Pain ◽  
Minimally Invasive ◽  
Intractable Pain ◽  
Tubular Retractor ◽  
Content Type ◽  
Novel Technique ◽  
Pain Syndromes ◽  
Hospital Stays ◽  
Fine Print

✓ The authors describe a novel technique for the implantation of multipolar epidural spinal cord neurostimulator electrodes with the aid of a tubular retractor system. Spinal cord neurostimulation is used as a neuroaugmentive tool for treating chronic intractable pain syndromes. Minimally invasive placement of the multipolar neurostimulator electrodes may allow for shorter hospital stays and less postoperative pain associated with the incision.

Imaging correlates of successful endoscopic third ventriculostomy

2000 ◽  
Vol 92 (6) ◽  
pp. 915-919 ◽  
Author(s):  
Abhaya V. Kulkarni ◽  
James M. Drake ◽  
Derek C. Armstrong ◽  
Peter B. Dirks
Keyword(s):  
Clinical Success ◽  
Subjective Assessment ◽  
Third Ventriculostomy ◽  
Ventricular Size ◽  
Content Type ◽  
Exact Test ◽  
Subjective Assessments ◽  
Flow Void ◽  
Fine Print

Object. The goal of this study was to determine and compare imaging correlates in pediatric patients who underwent successful or failed endoscopic third ventriculostomies (ETVs). To this end, the authors measured ventricular size changes and the presence of cerebrospinal fluid (CSF) flow void in both groups of children following ETV.Methods. Images obtained in children with hydrocephalus immediately before and at least 30 days after having undergone ETV were reviewed by four independent observers (two blinded and two nonblinded). Each observer independently measured the frontal and occipital horn ratio ([FOR], a reliable and valid measure of ventricular size) and provided a subjective assessment of the presence of a flow void at the ETV site, the degree of periventricular edema, and the amount of CSF over the cerebral hemispheres.There were 29 children whose mean age was 6.6 years at the time of ETV and who had a mean postoperative follow-up period lasting 1.6 years. Postoperatively, the mean reduction in ventricular size (as measured using the FOR) was 7% (95% confidence interval [CI] 3–11%) in cases that were deemed failures (eight patients) and 16% (95% CI 12–20%) in clinically successful cases (21 patients). This reduction was significantly greater in cases of clinical success compared with those that were deemed failures (p = 0.03, t-test). There were no substantial differences between blinded and nonblinded assessments. Flow void was present in 94% of successes and absent in 75% of failures (p = 0.01, Fisher's exact test). The other subjective assessments were not significantly different between the groups of successes and failures.Conclusions. Ventricular size appears to be somewhat reduced in both groups of patients who underwent clinically successful and failed ETV; however, the reduction is significantly greater among clinically successful cases. The presence of a flow void also appears to correlate with clinical success and its absence with clinical failure.

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