Bruce Jeffrey N, Ogden Alfred T
Department of Neurological Surgery, The Neurological Institute, Columbia University, New York, NY 10032, USA.
J Neurooncol. 2004 Aug-Sep;69(1-3):221-36. doi: 10.1023/b:neon.0000041885.09226.2d.
Optimal management of pineal region tumors depends on securing an accurate histologic diagnosis to facilitate management customized to the nuances of specific pathologies. As an initial step, surgical intervention by either stereotactic biopsy or open surgery is necessary to obtain tissue for pathologic examination. Stereotactic biopsy has the benefit of relative ease and minimal morbidity but is associated with greater likelihood of diagnostic inaccuracy compared to open surgery where more extensive tissue sampling is possible. The role of surgical debulking in the management of pineal tumors is clearly defined for some tumors but is less evident for others. Among the one third of pineal tumors that are benign or low grade, complete surgical resection is achievable and constitutes optimal management with excellent long-term recurrence-free survival. The benefits of aggressive surgical resection among malignant tumors are less clear but several studies have correlated degree of tumor removal with improved outcome. Advances in technology, surgical technique, and post-operative care have minimized surgical complications, however all surgical procedures in the pineal region, including both stereotactic biopsy and open surgery, are potentially hazardous. Advanced judgment, experience, and expertise are necessary to achieve rates of success sufficient to justify aggressive management. Management strategies using stereotactic biopsy, endoscopy, and radiosurgery can also provide favorable outcomes in some cases. Selective incorporation of these innovations can be expected to improve the already highly favorable outcome for all pineal region tumors.
松果体区肿瘤的最佳管理取决于获得准确的组织学诊断，以便根据特定病理的细微差别定制管理方案。作为第一步，通过立体定向活检或开放手术进行手术干预以获取组织进行病理检查是必要的。立体定向活检具有相对简便且发病率低的优点，但与开放手术相比，诊断不准确的可能性更大，因为开放手术可以进行更广泛的组织采样。手术减瘤在松果体肿瘤管理中的作用对于某些肿瘤已明确界定，但对其他肿瘤则不太明显。在三分之一的良性或低级别松果体肿瘤中，可实现完全手术切除，这构成了最佳管理方案，并具有出色的长期无复发生存率。在恶性肿瘤中积极手术切除的益处尚不清楚，但多项研究已将肿瘤切除程度与改善的预后相关联。技术、手术技术和术后护理的进步已将手术并发症降至最低，然而松果体区的所有手术程序，包括立体定向活检和开放手术，都具有潜在危险性。需要先进的判断力、经验和专业知识才能获得足以证明积极管理合理的成功率。在某些情况下，使用立体定向活检、内镜检查和放射外科的管理策略也可以提供良好的结果。预计选择性纳入这些创新将改善所有松果体区肿瘤本已非常良好的预后。
