Accilien Stenia, Coggins William S, Sasaki-Adams Deanna, Albert Gregory W, Bielamowicz Kevin J, Wilson David, Glasier Charles M, Gokden Murat, Tanaka Tomoko
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Division of Neurosurgery, Arkansas Children's Hospital, Little Rock, Arkansas.
J Neurosurg Case Lessons. 2025 May 12;9(19). doi: 10.3171/CASE24804.
Intracranial germinomas are rare pediatric tumors classically occurring in the pineal region, the infundibular recess, and septal region. Hypothalamic-optic pathway gliomas are typically pilocytic astrocytomas that can occur at any point along the optic pathway or within the hypothalamus. Germinomas are highly radiosensitive and chemotherapy-sensitive with an overall good prognosis after treatment. In contrast, hypothalamic-optic pathway gliomas are typically managed with observation if asymptomatic and treated with chemotherapy or targeted therapies if they are symptomatic or progressive.
Suprasellar germinomas are a known alternative location; however, suprasellar germinomas extending along the optic pathway are exceedingly rare. Neurosurgeons, neuroradiologists, and neuro-oncologists should consider germinomas when crafting a differential around a midline suprasellar lesion involving the optic pathway. Given the differences in treatment of a germinoma versus an optic pathway glioma, obtaining sufficient tissue for a diagnosis is paramount in these rare cases with radiographic equipoise.
The authors report a case of a suprasellar germinoma mimicking an optic pathway glioma in its radiographic appearance. The intraoperative appearance of the lesion during the attempted transsphenoidal biopsy appeared consistent with an optic pathway glioma. Subsequent biopsy via a pterional approach confirmed the diagnosis of germinoma. https://thejns.org/doi/10.3171/CASE24804.
颅内生殖细胞瘤是罕见的儿科肿瘤，典型地发生于松果体区、漏斗隐窝和隔区。下丘脑 - 视路胶质瘤通常为毛细胞型星形细胞瘤，可发生于视路的任何部位或下丘脑内。生殖细胞瘤对放疗和化疗高度敏感，治疗后总体预后良好。相比之下，下丘脑 - 视路胶质瘤如果无症状通常采取观察，如果有症状或病情进展则采用化疗或靶向治疗。
鞍上生殖细胞瘤是一个已知的好发部位；然而，沿视路延伸的鞍上生殖细胞瘤极为罕见。神经外科医生、神经放射科医生和神经肿瘤学家在对涉及视路的中线鞍上病变进行鉴别诊断时应考虑生殖细胞瘤。鉴于生殖细胞瘤与视路胶质瘤治疗方法的差异，在这些影像学表现相似的罕见病例中获取足够的组织进行诊断至关重要。
作者报告了一例鞍上生殖细胞瘤，其影像学表现酷似视路胶质瘤。在尝试经蝶窦活检时病变的术中表现似乎与视路胶质瘤一致。随后通过翼点入路活检确诊为生殖细胞瘤。https://thejns.org/doi/10.3171/CASE24804 。
