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Advances and Technical Standards in... 2023Posterior tentorial incisura not infrequently requires to be exposed for tumors of pineal gland, pulvinar, midbrain and cerebellum, aneurysms, arteriovenous...
Posterior tentorial incisura not infrequently requires to be exposed for tumors of pineal gland, pulvinar, midbrain and cerebellum, aneurysms, arteriovenous malformations. Residing almost at the center of the brain, this area is almost equal distance to any point on the calvarium behind coronal sutures enabling alternative routes to encounter. Compared to supratentorial routes either subtemporal or suboccipital approach, infratentorial supracerebellar route has several advantages as providing shortest, most direct approach to the lesions of this area without encountering any important arteries and veins. Since its initial description at the early twentieth century, a wide range of complications arising from cerebellar infarction, air embolism, and neural tissue damage have been encountered. Working in a deep, narrow corridor without enough illumination and visibility under very limited anesthesiology support hindered popularization of this approach. In the contemporary era of neurosurgery, advanced diagnostic tools and surgical microscopes with state-of-the-art microsurgery techniques coupled with modern anesthesiology have eliminated almost all drawbacks of infratentorial supracerebellar approach.
Topics: Humans; Neurosurgical Procedures; Pineal Gland; Pinealoma; Veins; Brain Neoplasms
PubMed: 37318569
DOI: 10.1007/978-3-031-28202-7_3 -
World Neurosurgery Dec 2022This study was to analyze the advantages and disadvantages of endoscopic midline and paramedian supracerebellar infratentorial approaches (EM-SCITA and EPM-SCITA) for...
OBJECTIVE
This study was to analyze the advantages and disadvantages of endoscopic midline and paramedian supracerebellar infratentorial approaches (EM-SCITA and EPM-SCITA) for pineal region tumors.
METHODS
We retrospectively analyzed the clinical data of 58 patients who underwent EM-SCITA and EPM-SCITA for pineal region tumors. Among them, 23 patients were treated with EM-SCITA, and 35 with EPM-SCITA. The patients were followed up for 6-84 months with magnetic resonance imaging and Karnofsky Performance Status scores.
RESULTS
The average age of the patients was 37.98 years, and there were 16 women (27.6%). The average maximum diameter of the tumors was 2.92 cm. Gross total resection was achieved in 46 patients (79.31%). There were 45 patients (77.6%) whose Karnofsky Performance Status score was >70 at the final follow-up. There was no significant difference among the above items between EM-SCITA and EPM-SCITA. However, EM-SCITA required a longer craniotomy and closure time, with a larger bone and dural flap, with more bridging veins sacrificed. EPM-SCITA simplified the opening of the quadrigeminal cistern, and it was beneficial to expose the contralateral wall of the third ventricle. The longer and angled path limited the exposure of the anterior third ventricle and the ipsilateral wall of the third ventricle.
CONCLUSIONS
Both approaches had remarkable clinical effects. The anatomy of EM-SCITA was easy to understand and has a larger operating space; it is suitable for neurosurgical beginners. In contrast, EPM-SCITA has limited operation space, an intricate anatomy, and is suitable for experienced operators. The occurrence of postoperative hydrocephalus should be alerted by EPM-SCITA.
Topics: Humans; Female; Adult; Retrospective Studies; Pinealoma; Craniotomy; Pineal Gland; Brain Neoplasms
PubMed: 36152938
DOI: 10.1016/j.wneu.2022.09.074 -
Brain Research Jul 2016The Unfolded Protein Response (UPR) is an adaptive cellular program used by eukaryotic cells to cope with protein misfolding stress in the Endoplasmic Reticulum (ER).... (Review)
Review
The Unfolded Protein Response (UPR) is an adaptive cellular program used by eukaryotic cells to cope with protein misfolding stress in the Endoplasmic Reticulum (ER). During tumor development, cancer cells are facing intrinsic (oncogene activation) and extrinsic (limiting nutrient or oxygen supply; exposure to chemotherapies) challenges, with which they must cope to survive. Primary brain tumors are relatively rare but deadly and present a significant challenge in the determination of risk factors in the population. These tumors are inherently difficult to cure because of their protected location in the brain. As such surgery, radiation and chemotherapy options carry potentially lasting patient morbidity and incomplete tumor cure. Some of these tumors, such as glioblastoma, were reported to present features of ER stress and to depend on UPR activation to sustain growth, but to date there is no clear general representation of the ER stress status in primary brain tumors. In this review, we describe the key molecular mechanisms controlling the UPR and their implication in cancers. Then we extensively review the literature reporting the status of ER stress in various primary brain tumors and discuss the potential impact of such observation on patient stratification and on the possibility of developing appropriate targeted therapies using the UPR as therapeutic target.
Topics: Animals; Brain Neoplasms; Cerebellar Neoplasms; Choroid Plexus Neoplasms; Endoplasmic Reticulum Stress; Glioblastoma; Humans; Medulloblastoma; Meningeal Neoplasms; Meningioma; Pineal Gland; Pinealoma; Signal Transduction; Unfolded Protein Response
PubMed: 27016056
DOI: 10.1016/j.brainres.2016.03.015 -
Journal of Magnetic Resonance Imaging :... Oct 2014To investigate the relation between circadian saliva melatonin levels and pineal volume as determined by MRI. Plasma melatonin levels follow a circadian rhythm with a... (Clinical Trial)
Clinical Trial
PURPOSE
To investigate the relation between circadian saliva melatonin levels and pineal volume as determined by MRI. Plasma melatonin levels follow a circadian rhythm with a high interindividual variability.
MATERIALS AND METHODS
In 103 healthy individuals saliva melatonin levels were determined at four time points within 24 h and MRI was performed once (3.0 Tesla, including three-dimensional T2 turbo spin echo [3D-T2-TSE], susceptibility-weighted imaging [SWI]). Pineal volume as well as cyst volume were assessed from multiplanar reconstructed 3D-T2-TSE images. Pineal calcification volume tissue was determined on SWI. To correct for hormonal inactive pineal tissue, cystic and calcified areas were excluded. Sleep quality was assessed with the Landeck Inventory for sleep quality disturbance.
RESULTS
Solid and uncalcified pineal volume correlated to melatonin maximum (r = 0.28; P < 0.05) and area under the curve (r = 0.29; P < 0.05). Of interest, solid and uncalcified pineal volume correlated negatively with the sleep rhythm disturbances subscore (r = -0.17; P < 0.05) despite a very homogenous population.
CONCLUSION
Uncalcified solid pineal tissue measured by 3D-T2-TSE and SWI is related to human saliva melatonin levels. The analysis of the sleep quality and pineal volume suggests a linkage between better sleep quality and hormonal active pineal tissue.
Topics: Adolescent; Adult; Circadian Rhythm; Female; Humans; Image Interpretation, Computer-Assisted; Imaging, Three-Dimensional; Magnetic Resonance Imaging; Male; Melatonin; Organ Size; Pineal Gland; Reproducibility of Results; Saliva; Sensitivity and Specificity; Sleep Stages; Statistics as Topic; Young Adult
PubMed: 24214660
DOI: 10.1002/jmri.24449 -
Neuroimaging Clinics of North America Nov 2016Some brain tumors results are interesting due to their rarity at presentation and overwhelming imaging characteristics, posing a diagnostic challenge in the eyes of any... (Review)
Review
Some brain tumors results are interesting due to their rarity at presentation and overwhelming imaging characteristics, posing a diagnostic challenge in the eyes of any experienced neuroradiologist. This article focuses on the most important features regarding epidemiology, location, clinical presentation, histopathology, and imaging findings of cases considered "bizarre." A review of the most recent literature dealing with these unusual tumors and pseudotumors is presented, highlighting key points related to the diagnosis, treatments, outcomes, and differential diagnosis.
Topics: Adult; Brain; Brain Diseases; Brain Neoplasms; Diagnosis, Differential; Diagnostic Imaging; Humans; Neuroimaging; Pineal Gland; Pinealoma; Vascular Malformations
PubMed: 27712799
DOI: 10.1016/j.nic.2016.06.012 -
Der Radiologe Aug 2014The (supra) sellar and pineal regions are relatively common sites for pediatric brain tumors; however, the distinct spectrum of space-occupying lesions is in marked... (Review)
Review
The (supra) sellar and pineal regions are relatively common sites for pediatric brain tumors; however, the distinct spectrum of space-occupying lesions is in marked contrast to that of the adult population. Craniopharyngeoma represents the most common intrasellar and/or suprasellar lesion in children, whereas the pituitary adenoma typical for adults- is generally rare. The pineal region is a predilection site for germ cell tumors in pediatric patients, while in adults this cancer category is largely confined to the gonads. The role of imaging is in the early detection of lesions, adequate demonstration of the characteristics and delineation of the complex anatomical relationship to adjacent vital structures.
Topics: Child; Child, Preschool; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Pineal Gland; Pinealoma; Pituitary Neoplasms
PubMed: 25081918
DOI: 10.1007/s00117-014-2668-9 -
Acta Radiologica (Stockholm, Sweden :... Feb 2022High-grade pineal region tumors are rare and heterogeneous types of primary central nervous system neoplasms; radiological differential diagnosis is challenging but it...
BACKGROUND
High-grade pineal region tumors are rare and heterogeneous types of primary central nervous system neoplasms; radiological differential diagnosis is challenging but it is important because it has a therapeutic relevance.
PURPOSE
To discriminate among high-grade pineal region tumors by combining apparent diffusion coefficient (ADC) volumetric values and qualitative features in order to predict their histology.
MATERIAL AND METHODS
Twenty-two patients with high-grade pineal region tumors were assessed by qualitative and quantitative analysis. Margins, T2-weighted signal intensity, contrast enhancement, hemorrhage, calcifications, different volumetric ADC fractions (ADC, ADC, ADC) were evaluated and were compared to the histopathologic findings (cell count and proliferation index).
RESULTS
Our qualitative imaging data showed that only margins were different among different tumors and each tumor type showed peculiar age onset. ADC was found the best quantitative value to discriminate high-grade tumors of the pineal region. ADC correlated with proliferation index but not with cell count. ADC values were lower in tumors with higher proliferation rate and a significant difference in ADC values were found between germinomas and pineoblastomas, between germinomas and papillary tumors and between papillary tumors and pineoblastomas. Moreover, the cut-off value of 0.865 × 10 mm/s for ADC (ADC mean threshold value) could differentiate germinoma from pineoblastomas with the best combination of sensitivity and specificity.
CONCLUSION
The ADC value measured on the whole tumor, reflecting tumor proliferative activity, may be a practical and non-invasive marker for predicting tumor histology in high-grade pineal region lesions and might be useful in preoperative assessment.
Topics: Adolescent; Adult; Brain Neoplasms; Calcinosis; Cell Proliferation; Cerebral Hemorrhage; Child; Child, Preschool; Diffusion Magnetic Resonance Imaging; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neuroimaging; Pineal Gland; Retrospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 33497274
DOI: 10.1177/0284185120986912 -
World Neurosurgery Dec 2022Most pineal cysts are not surgical lesions and should be conservatively managed. Select lesions, notably those that present with hydrocephalus and Parinaud syndrome and...
Most pineal cysts are not surgical lesions and should be conservatively managed. Select lesions, notably those that present with hydrocephalus and Parinaud syndrome and lesions presenting with symptoms consistent with intermittent blockage of cerebrospinal fluid pathways and/or neurovascular compression, however, can be considered for surgical intervention. Two workhorse surgical approaches to the pineal region include the occipital interhemispheric transtentorial and supracerebellar infratentorial approaches. Each approach provides unique benefits and drawbacks and is associated with morbidities. In this patient, we demonstrate the use of a minimally invasive, supine, lateral supracerebellar infratentorial approach to the pineal region (Video 1). The approach makes use of early access to the foramen magnum to release cerebrospinal fluid for cerebellar relaxation, followed by navigation-guided, minimal dissection of the supracerebellar potential space to arrive at the pineal cyst. Opening of the arachnoid membranes ventrolateral to the confluence of the deep cerebral veins allows for direct access to the cyst with minimal manipulation of the venous complex and risk for injury. The cyst is then fenestrated, and the cyst capsule is removed. It should be noted that surgical fenestration does not guarantee relief of headache symptoms, and patients should be consoled about this preoperatively.
Topics: Humans; Pinealoma; Pineal Gland; Brain Neoplasms; Central Nervous System Cysts; Cysts
PubMed: 36174946
DOI: 10.1016/j.wneu.2022.09.084 -
International Journal of Radiation... Nov 2018
Topics: Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Pineal Gland
PubMed: 30238897
DOI: 10.1016/j.ijrobp.2018.05.031 -
World Neurosurgery Mar 2022Pineal region metastases are rare but often cause severe neurologic deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated... (Review)
Review
BACKGROUND
Pineal region metastases are rare but often cause severe neurologic deficits. Surgical resection and chemoradiotherapy can provide therapeutic benefit. We investigated the literature to analyze clinical characteristics, management strategies, and survival of adult patients with pineal region metastases.
METHODS
PubMed, Embase, Scopus, and Cochrane were searched following the PRISMA guidelines, including studies reporting clinical outcomes of patients with pineal region metastases. Clinical presentation, management, and survival were reviewed.
RESULTS
We included 31 studies comprising 47 patients. Lung cancer (29.8%) and carcinomas of unknown origin (14.9%) were the most frequent primary tumors. In 48.9% of patients, symptomatic pineal metastases preceded primary tumor diagnosis. Headache (67.4%) and confusion (46.5%) were the most common symptoms. Parinaud syndrome (46.5%) and hydrocephalus (87.2%) were noted. Biopsy (65.9%) was preferred over resection (34.1%), and shunting strategies used were endoscopic third ventriculostomy (43.9%) and ventriculoperitoneal (26.8%). Eleven patients (32.3%) received adjuvant chemotherapy and 32 (68%) received radiotherapy. Posttreatment improvement in symptoms (56.6%) and hydrocephalus (80.5%) were noted. In patients who received adjuvant chemotherapy/radiotherapy, significant improvement in posttreatment performance status occurred with both biopsy (P < 0.001) and resection (P = 0.007). No survival differences were reported between surgery and biopsy (P = 0.912) or between complete and partial resection (P = 0.220). Overall survival was neither influenced by surgical approach (P = 0.157) nor by shunting strategy (P = 0.822). Mean follow-up was 8 months and median overall survival 3 months. Only 2 cases (4.8%) of pineal metastasis showed recurrence.
CONCLUSIONS
Pineal region metastases carry significant morbidity. Biopsy or surgical resection, combined with adjuvant chemotherapy/radiotherapy and/or shunting, may significantly improve performance status.
Topics: Adult; Brain Neoplasms; Humans; Hydrocephalus; Pineal Gland; Pinealoma; Ventriculostomy
PubMed: 34999267
DOI: 10.1016/j.wneu.2022.01.005