Ahmed Mamoun, Arend Roman, Nordin Niels, Scholz Martin, Suchorska Bogdana, Lucaciu Robert, Jung Suzin
Department of Neurosurgery, Sana Kliniken Duisburg, Academic Teaching Hospital of University Duisburg-Essen, Duisburg, Germany.
Department of Neurosurgery, Heidelberg University Hospital, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany.
Neurosurg Rev. 2025 Jan 30;48(1):107. doi: 10.1007/s10143-025-03259-w.
Pineal gland lesions pose a significant surgical challenge due to the deep-seated nature of the pineal gland, as well as the limited field of view, and the complex vascular anatomy. The mainstay of surgical treatment, when necessary, is always histopathological clarity and gross total resection (GTR). We evaluate the surgical outcomes for pineal gland lesions, shedding light on functional outcomes, histological findings, and surgical complications. We analyzed patients with pineal gland lesions who underwent surgical treatment in our institution between September 2013 and May 2022. Patient demographics, clinical symptoms, surgical approaches, resection extent, surgery-related complications, and histopathological diagnosis were studied. Pre- and postoperative functional outcomes were assessed using the modified Rankin Scale (mRS) and were compared using the Student´s t-test. 32 patients (13 males, 19 females) were included. The mean age was 39 years old. We adopted the infratentorial supracerebellar approach (ITSC) in a semi-sitting position. 2 of these patients received preoperatively an endoscopic third ventriculocisternostomy (ETV) combined with endoscopic biopsy. The mean operating time for the ITSC approach was 170 min, whereas 53 min for the ETV with endoscopic biopsy. The mean length of stay was 13 days. The most common histopathological diagnosis was pineal cysts (38%). Surgical mortality was 0%, and morbidity was 28%. GTR was possible in 72% of patients treated using the ITSC approach. There was a functional outcome improvement, with a statistical significance measured via the Student´s t-test (p = 0.047). The ITSC approach remains safe and feasible when performed by an experienced surgical team, yielding a histopathological diagnosis and improvement of functional status.
松果体病变因其位置深在、视野受限以及血管解剖结构复杂，给手术带来了巨大挑战。必要时，手术治疗的关键始终是实现组织病理学清晰诊断和大体全切（GTR）。我们评估了松果体病变的手术效果，包括功能转归、组织学发现和手术并发症。我们分析了2013年9月至2022年5月间在我院接受手术治疗的松果体病变患者。研究了患者的人口统计学资料、临床症状、手术入路、切除范围、手术相关并发症以及组织病理学诊断。采用改良Rankin量表（mRS）评估术前和术后的功能转归，并使用Student's t检验进行比较。纳入32例患者（男性13例，女性19例），平均年龄39岁。我们采用半坐位经小脑幕下小脑上入路（ITSC）。其中2例患者术前接受了内镜下第三脑室造瘘术（ETV）联合内镜活检。ITSC入路的平均手术时间为170分钟，而ETV联合内镜活检的手术时间为53分钟。平均住院时间为13天。最常见的组织病理学诊断是松果体囊肿（38%）。手术死亡率为0%，发病率为28%。采用ITSC入路治疗的患者中，72%实现了大体全切。功能转归有改善，经Student's t检验具有统计学意义（p = 0.047）。由经验丰富的手术团队实施时，ITSC入路仍然安全可行，可实现组织病理学诊断并改善功能状态。
