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:
Review
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
1. Aoki N. Combined occipital transtentorial and infratentorial supracerebellar approach in the concorde position for the treatment of an arteriovenous malformation in the upper vermis: case report. Neurosurgery 1985;17:815–7.
2. Aryan HE, Ozgur BM, Jandial R, et al. Complications of interhemispheric transcallosal approach in children: review of 15 years experience. Clin Neurol Neurosurg 2006;108:790–3.
3. Azab WA, Nasim K, Salaheddin W. An overview of the current surgical options for pineal region tumors. Surg Neurol Int 2014;5:39.
4. Balossier A, Blond S, Touzet G, et al. Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience. Neurochirurgie 2015;61:146–54.
5. Beck H, Moriyama E. Transverse sinus-tentorium splitting approach for pineal region tumors – case report. Neurol Med Chir (Tokyo) 2001;41:217–21.
6. Berhouma M, Ni H, Delabar V, et al. Update on the management of pineal cysts: Case series and a review of the literature. Neurochirurgie 2015;61:201–7.
7. Broggi M, Darbar A, Teo C. The value of endoscopy in the total resection of pineocytomas. Neurosurgery 2010;67(3 Suppl Operative): 159–65.
8. Brugger P, Marktl W, Herold M. Impaired nocturnal secretion of melatonin in coronary heart disease. Lancet (London, England) 1995;345:1408.
9. Buchvald P, Suchomel P, Beneš V, et al. Expanze pineální krajiny. Česká a Slov Neurol a Neurochir časopis českých a Slov Neurol a Neurochir 2013;76:667–77.
10. Dallier F, Di Roio C. Sitting position for pineal surgery: Some anaesthetic considerations. Neurochirurgie 2015;61:164–7.
11. Dandy WE. Operative experience in cases of pineal tumor. Arch Surg 1936;33:19.
12. Ellenbogen RG, Moores LE. Endoscopic management of a pineal and suprasellar germinoma with associated hydrocephalus. Minim Invasive Neurosurg 1997;40:13−5,discussion 16.
13. Ferrer E, Santamarta D, Garcia-Fructuoso G, et al. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien) 1997;139:12–21.
14. Ferrier IN, Arendt J, Johnstone EC, et al. Reduced nocturnal melatonin secretion in chronic schizophrenia: relationship to body weight. Clin Endocrinol (Oxf) 1982;17:181–7.
15. Gore PA, Gonzalez LF, Rekate HL, et al. Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Neurosurgery 2008;62(3 Suppl 1):108–9; discussion 109.
16. Hart MG, Santarius T, Kirollos RW. How I do it - Pineal surgery: Supracerebellar infratentorial versus occipital transtentorial. 2013 Acta Neurochir (Wien) 2013;155:463–7.
17. Hernesniemi J, Romani R, Albayrak BS, et al. Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 2008;70:576–83.
18. Chernov MF, Kamikawa S, Yamane F, et al. Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery 2006;59:267–77,discussion 267–77.
19. Jakola AS, Bartek J, Mathiesen T. Venous complications in supracerebellar infratentorial approach. Acta Neurochir (Wien) 2013;155:477–8.
20. Kennedy BC, Bruce JN. Surgical approaches to the pineal region. Neurosurg Clin N Am2011; 22:367–80.
21. Klein DC, Moore RY. Pineal N-acetyltransferase and hydroxyindole-O-methyltransferase: control by the retinohypothalamic tract and the suprachiasmatic nucleus. Brain Res 1979;174:245–62.
22. Kodera T, Bozinov O, Sürücü O, et al. Neurosurgical venous considerations for tumors of the pineal region resected using the infratentorial supracerebellar approach. J Clin Neurosci 2011;18:1481–5.
23. Kulwin C, Matsushima K, Malekpour M, et al. Lateral supracerebellar infratentorial approach for microsurgical resection of large midline pineal region tumors: techniques to expand the operative corridor. J Neurosurg 2016;124:269–76.
24. Lehecka M, Laakso A, Hernesniemi J. Helsinki microneurosurgery basics and tricks. 2011
25. Leston J, Mottolese C, Champier J, et al. Contribution of the daily melatonin profile to diagnosis of tumors of the pineal region.J Neurooncol 2009;93:387–94.
26. Macchi MM, Bruce JN. Human pineal physiology and functional significance of melatonin. Front Neuroendocrinol 2004;25:177–95.
27. Májovský M, Netuka D, Beneš V. Clinical management of pineal cysts: a worldwide online survey. Acta Neurochir (Wien) 2016;158:663–9.
28. Mirski MA, Lele AV, Fitzsimmons L, et al. Diagnosis and treatment of vascular air embolism. Anesthesiology 2007;106:164–77.
29. Morgenstern PF, Osbun N, Schwartz TH, et al. Pineal region tumors: an optimal approach for simultaneous endoscopic third ventriculostomy and biopsy. Neurosurg Focus 2011;30:E3.
30. O’Brien DF, Hayhurst C, Pizer B, et al. Outcomes in patients undergoing single-trajectory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 2006;105(3 Suppl):219–26.
31. de Oliveira JG, Párraga RG, Chaddad-Neto F, et al. Supracerebellar transtentorial approach-resection of the tentorium instead of an opening-to provide broad exposure of the mediobasal temporal lobe: anatomical aspects and surgical applications: clinical article. 2012 J Neurosurg 2012;116:764–72.
32. Pavelka Z, Smrčka M, Křen L, et al. Papilární nádor pineální oblasti u dítěte – kazuistika. Ces Slov Neurol N 2012;75:754–6.
33. Qi S, Fan J, Zhang X, et al. Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir (Wien) 2014;156:2253–62.
34. Radovanovic I, Dizdarevic K, de Tribolet N, et al. Pineal region tumors – neurosurgical review. Med Arh 2009;63:171–3.
35. Sakotnik A, Liebmann PM, Stoschitzky K, et al. Decreased melatonin synthesis in patients with coronary artery disease. Eur Heart J 1999;20:1314–7.
36. Shahinian H, Ra Y. Fully endoscopic resection of pineal region tumors. J Neurol Surg B Skull Base 2013;74:114–7.
37. Shirane R, Shamoto H, Umezawa K, et al. Surgical treatment of pineal region tumours through the occipital transtentorial approach: evaluation of the effectiveness of intra-operative micro-endoscopy combined with neuronavigation. Acta Neurochir (Wien) 1999;141:801–9.
38. Schubert A, Deogaonkar A, Drummond JC. Precordial Doppler probe placement for optimal detection of venous air embolism during craniotomy. Anesth Analg 2006;102:1543–7.
39. Sood S, Hoeprich M, Ham SD. Pure endoscopic removal of pineal region tumors. Childs Nerv Syst 2011;27:1489–92.
40. Tanaka R, Washiyama K. Occipital transtentorial approach to pineal region tumors. Oper Tech Neurosurg 2003;6:215–21.
41. Tirakotai W, Schulte DM, Bauer BL, et al. Neuroendoscopic surgery of intracranial cysts in adults. Child’s Nerv Syst 2004;20:842–51.
42. Vasiljevic A, Szathmari A, Champier J, et al. Histopathology of pineal germ cell tumors. Neurochirurgie 2015; 61:130–7.
43. Webb SM, Puig-Domingo M. Role of melatonin in health and disease. Clin Endocrinol (Oxf) 1995;42:221–34.
44. Yamamoto I. Pineal region tumor: surgical anatomy and approach. J Neurooncol 2001;54:263–75.
45. Zacharia BE, Bruce JN. Stereotactic biopsy considerations for pineal tumors. Neurosurg Clin N Am 2011;22:359–66, viii.
46. Zapletal B. Ein neuer operativer Zugang zum Gebiet der incisura Tentorii. Zentralblatt für Neurochir 1956;16:64–9.
47. Ziyal IM, Sekhar LN, Salas E, et al. Combined supra/infratentorial-transsinus approach to large pineal region tumors. J Neurosurg 1998;88:1050–7.
48. Čapek Š, Škvor J, Neubertová E, et al.. Mikrochirurgická léčba symptomatických pineálních cyst. Cesk Slov Neurol N 2014;110: 90−5.
Štítky
Surgery Orthopaedics Trauma surgeryČlánok vyšiel v časopise
Perspectives in Surgery
2016 Číslo 8
- Spasmolytic Effect of Metamizole
- Metamizole at a Glance and in Practice – Effective Non-Opioid Analgesic for All Ages
- Metamizole in perioperative treatment in children under 14 years – results of a questionnaire survey from practice
Najčítanejšie v tomto čísle
- Surgical approaches to pineal region – review article
- Treatment of acute appendicitis: Retrospective analysis
- Free-floating thrombus in the internal carotid artery treated by anticoagulation and delayed carotid endarterectomy
- Supravesical hernia as a rare cause of inguinal herniation and its laparoscopic treatment with TAPP approach