Hu Xing, Ren Yan-Ming, Yang Xiang, Liu Xiao-Dong, Huang Bo-Wen, Chen Teng-Yun, Jv Yan, Lan Zhi-Gang, Liu Wen-Ke, Liu Xue-Song, Hui Xu-Hui, Liu Jing-Ping, Zhang Yue-Kang
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, PR China.
Department of Neurosurgery, The First Xiangya Hospital, Xiangya Medical College, Central South University, Changsha, Hunan, China.
World Neurosurg. 2023 Apr;172:e1-e11. doi: 10.1016/j.wneu.2022.09.091. Epub 2022 Sep 24.
The pineal tumor was once considered as a restricted area for surgery. Such cases are rare, with many different opinions on surgical treatment. This study aimed to review our experience of tumor treatment in the pineal region and explore the optimal treatment strategy.
The clinical data of 72 patients with pineal tumors from January 1997 to May 2015 (18 years) were retrospectively analyzed. Preoperative preparation, pathology type, tumor resection rate, surgical approach, and follow-up outcomes were used as the indicators to evaluate the treatment efficacy.
The Krause approach was used in 46 cases, the Poppen approach in 10 cases, and the transcallosal-lateral ventricle-choroid fissure approach in 16 cases. The postoperative pathological results were as follows: 24 cases of germinoma, 11 of teratoma, 15 of glioma, 6 of meningioma, 11 of Pineocytoma, 2 of cholesteatoma, 2 of cavernous hemangioma, and 1 of choriocarcinoma. Further, the study included 64 cases of total surgical resections, 8 of subtotal resections, and 2 deaths. The follow-up period was from 7 months to 10 years. Further, 51 (70.8%) patients were followed up. The multivariate regression model showed that the surgical method and the pathological type contributed significantly to predicting outcomes.
The type of pathology, extent of excision, and surgical approach had a significant impact on the prognosis of patients. The transcallosal-lateral ventricle-choroid fissure approach for large and medium-sized pineal tumors near the posterior part of the third ventricle had good efficacy.
松果体肿瘤曾被认为是手术禁区。此类病例罕见，关于手术治疗存在诸多不同观点。本研究旨在回顾我们在松果体区肿瘤治疗方面的经验，并探索最佳治疗策略。
回顾性分析1997年1月至2015年5月（18年）72例松果体肿瘤患者的临床资料。以术前准备、病理类型、肿瘤切除率、手术入路及随访结果作为评估治疗效果的指标。
采用克劳斯入路46例，波彭入路10例，经胼胝体-侧脑室-脉络膜裂入路16例。术后病理结果如下：生殖细胞瘤24例，畸胎瘤11例，胶质瘤15例，脑膜瘤6例，松果细胞瘤11例，胆脂瘤2例，海绵状血管瘤2例，绒毛膜癌1例。此外，本研究包括64例全切除、8例次全切除及2例死亡。随访时间为7个月至10年。进一步地，51例（70.8%）患者获得随访。多因素回归模型显示手术方法和病理类型对预测预后有显著影响。
病理类型、切除范围及手术入路对患者预后有显著影响。经胼胝体-侧脑室-脉络膜裂入路治疗第三脑室后部附近的大中型松果体肿瘤疗效良好。
