Abstract
The authors present a microsurgical technique for the resection of a heterogeneous
group of pineal-region tumors and discuss the key points for successfully performing
this surgery. Twenty-six consecutive patients with pineal-region tumors were resected
by the senior author (H.B.) and analyzed retrospectively. For all 26 patients, the
operation was conducted using the infratentorial supracerebellar (ITSC) approach in
the sitting (23 patients) or Concorde (three patients) positions. Twenty-five patients
had symptomatic obstructive hydrocephalus and were treated with ventricular drainage,
a previously inserted ventriculoperitoneal shunt, or an endoscopic third ventriculostomy
before undergoing resection of the pineal-region tumor. The gross total removal of
the tumor was achieved in 23 patients and subtotal removal was achieved in three patients.
The tumors were pathologically diagnosed mainly as pineocytomas (10), pilocytic astrocytomas
(6), or pineal cysts (4). Twenty-five of the patients clinically improved after surgery,
and there was no mortality. Two patients experienced transient postoperative neurological
deterioration: one patient developed Parinaud syndrome, and one patient developed
intermittent diplopia. Successful surgery and patient outcome when treating tumors
of the pineal region using the ITSC approach requires: (i) preservation of the venous
flow of the Galenic draining system; (ii) preservation of the thick bridging veins
of the tentorial surface of the cerebellum, especially the hemispheric bridging veins;
and (iii) minimizing retraction of the cerebellum during surgery to avoid adverse
effects caused by both direct cerebellar compression and disturbance of the venous
circulation.
Keywords
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Article info
Publication history
Accepted:
February 16,
2011
Received:
October 22,
2010
Identification
Copyright
© 2011 Elsevier Ltd. Published by Elsevier Inc. All rights reserved.
