Konovalov Alexander N, Pitskhelauri David I
Burdenko Neurosurgery Institute, Moscow, Russia.
Surg Neurol. 2003 Apr;59(4):250-68. doi: 10.1016/s0090-3019(03)00080-6.
A pineal region tumor is an uncommon deep-seated, heterogeneous group of mass lesions of the brain, and the management strategy of any types of these tumors remains controversial. It is the purpose of this communication to present results of our experience in treating patients with these neoplasms.
From 1976 to 1999 about 700 patients with tumors of the pineal region and posterior third ventricle were managed at the Burdenko Neurosurgery Institute. In more than 330 cases the tumor was removed. In this paper we present results of 287 patients with histologically verified pineal region tumors for the period from 1976 to 1999. All of them had verified tumor histology, excluding only five cases in which stereotactic biopsy procedures were uninformative. There are four main groups of tumors: the germ cell tumors-87 (31%); the pineal parenchymal tumors-75 (27%); the glial tumors-77 (27%); and miscellaneous-43 (15%). There were 255 surgical procedures for tumor removal performed in 244 and stereotactically guided biopsies in 61 patients, 168 (58%) with obstructive hydrocephalus who underwent cerebrospinal fluid shunting. Radiation therapy was administered in 145 (51%) and chemotherapy in 16 patients. Follow-up data were collected in 209 cases (80%). Survival was calculated with the Kaplan-Meier product limit method.
The occipital transtentorial and infratentorial supracerebellar approaches were the most commonly used on our series-138 (54%) and 87 (34%), respectively. In the remaining cases, subchoroidal approach, approach through the fourth ventricle, and the combined approaches were used. A total tumor removal was achieved in 148 operations (58%), subtotal in 74 (29%) and partial in 33 (13%). The projected 5-year and 10-year survival rates for patients with malignant pineal tumors, who received irradiation after tumor resection or underwent radiation therapy alone, were: 95% and 88% for pure germinomas, 80% and 50% for high grade gliomas, 44% and 0% for malignant pineal parenchymal tumors, and 20% and 0% for malignant germ cell tumors, respectively.
Benign pineal tumors should be cured with surgery alone. Malignant tumors should be treated with aggressive resection followed with irradiation and chemotherapy. Pure germinomas, which are exquisitely radiosensitive, can be cured by conventional radiation therapy alone.
松果体区肿瘤是一组罕见的脑深部、异质性肿块病变，这些肿瘤的任何类型的治疗策略仍存在争议。本报告旨在介绍我们治疗这些肿瘤患者的经验结果。
1976年至1999年期间，布尔坚科神经外科研究所收治了约700例松果体区和第三脑室后部肿瘤患者。超过330例患者的肿瘤被切除。本文介绍了1976年至1999年期间287例经组织学证实的松果体区肿瘤患者的结果。所有患者均经肿瘤组织学证实，仅排除5例立体定向活检未提供信息的病例。肿瘤主要分为四类：生殖细胞肿瘤87例（31%）；松果体实质肿瘤75例（27%）；神经胶质瘤77例（27%）；其他43例（15%）。244例患者进行了255次肿瘤切除手术，61例患者进行了立体定向活检，168例（58%）梗阻性脑积水患者接受了脑脊液分流术。145例（51%）患者接受了放射治疗，16例患者接受了化疗。收集了209例（80%）患者的随访数据。采用Kaplan-Meier乘积限法计算生存率。
在我们的系列研究中，枕下经小脑幕入路和幕下小脑上入路最常用，分别为138例（54%）和87例（34%）。在其余病例中，采用脉络膜下入路、经第四脑室入路和联合入路。148例手术（5
