PINEAL REGION TUMORS: SURGICAL MANAGEMENT AND PERSONAL EXPERIENCE

BACKGROUND The pineal region is one of the most complex regions to access because of its deep location, as well the presence of many neurovascular structures forming a natural obstacle to the surgical route. The repertoire of the surgical approaches to the pineal region has evolved considerably over the past 100 years, with an associated decline in operative mortality from 100% to less than 4%. The authors critically review the personal series of pineal region tumors focusing on the operative approaches most frequently used in dealing these lesions. MATERIALS AND METHODS A series of pineal and para-pineal tumors has been selected from the personal tumors’ registry. A wide review regarding the type of lesions, surgical positions, type of approaches and selection criteria for a specific type of approach has been performed. RESULTS In a range period of 10 years, 36 pineal tumors have been treated. Among these, 15 were men and 21 female. The mean age was 43.1 years. The most frequent lesion observed was 14 tentorial meningiomas. The most frequently employed approaches were the occipital trans-tentorial and supra-cerebellar infratentorial. All tumors were completely removed surgically without any injury to the venous complex. There was no incidence of mortality or morbidity in our group of patients, and all functional outcomes were good to excellent postoperatively. CONCLUSIONS Pineal tumors are considered challenging lesions very difficult to treat. According to the personal experience, the occipital trans-tentorial approach and the supra-cerebellar infratentorial approach with the patient in the prone, sitting or semi-sitting position are the most useful approach for the treatment of these lesions. A perfect knowledge of the anatomy of this region is to be considered mandatory to perform safely these kinds of approaches.