Surgical Strategies of Pineal Tumors. Local Experience with Neuroendoscopy or Stereotactic Biopsy as the First Step

Background: Pineal tumors are histopathologically heterogeneous and always show severe progression of clinical signs. Surgical treatment remains challenging because of the close vicinity of the deep venous system and the mesencephalo-diencephalic structures in this region. Objective: We present our surgical strategies and techniques in a consecutive series of twenty seven patients treated in Suez Canal University Hospital between 1999 and 2015.Our goal in this research is to discuss a novel algorithm to deal with pineal region tumors. Patients and Methods: In the Twelve patient presented with dilated ventricular system, we start by endoscopic 3rd ventriculostomy (ETV) and endoscopic tumor biopsy (ETB) in the same session. In the twelve patients without hydrocephalus, stereotactic biopsy of the pineal lesion was done. Further management was dependent on the pathology result. Germinoma is radiosensitive tumor and stereotactic radiosurgery is curative (fourteen patients). Otherwise, surgical excision was the usual approach (fourteen patients). Results: There were fifteen males and twelve females. The age range was 2.5 – 69 years with a mean age being 24.3 years. In the twelve patients with hydrocephalus, twelve ETVs and 11 ETBs were performed. ETV was successful in controlling the hydrocephalus in ten patients (83%) and also the histological diagnosis was achieved in 10/11 (91%) patients with ETB.12 patients underwent stereotactic biopsy. The diagnostic yield of stereotactic biopsy was 92%. Of the whole series fourteen patients underwent surgical resection.Conclusions: The proposed surgical strategy is safe and effective. It is associated with low morbidity, high intracranial pressure (ICP) control and definitive histopathologic diagnosis. Considering risk versus benefit, we therefore believe that this approach can be offered in most cases as the first treatment option for pineal tumors.