Surgical approaches to pineal region – review article
Authors:
M. Májovský; D. Netuka; V. Beneš
Authors place of work:
Neurochirurgická a neuroonkologická klinika 1. LF Univerzity Karlovy a ÚVN Praha, přednosta: prof. MUDr. V. Beneš, DrSc.
Published in the journal:
Rozhl. Chir., 2016, roč. 95, č. 8, s. 305-311.
Category:
Souhrnné sdělení
Summary
Introduction:
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.
Methods:
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.
Conclusion:
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.
Keywords:
pineal gland − pineal tumours − neurosurgical procedures – craniotomy − neuroendoscopy
Zdroje
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