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World Neurosurgery Jul 2020Thermal coagulation is a central principle in surgery, particularly regarding hemostasis, as well as being an integral part of intracranial tumor removal. Traditionally,...
BACKGROUND
Thermal coagulation is a central principle in surgery, particularly regarding hemostasis, as well as being an integral part of intracranial tumor removal. Traditionally, surgical hemostasis is achieved through application of unipolar or bipolar electrocautery. This method has been contemporized and specialized to treat intracranial tumors through a technique called stereotactic laser ablation (SLA), also known as laser interstitial thermal therapy.
CASE DESCRIPTION
In this article, we present this technique as an additional option in the treatment of difficult intracranial tumors. Specifically, we report here a highly vascular and hemorrhagic pineocytoma found in a fragile, elderly patient who underwent a novel combination of procedures: SLA mediated devascularization followed by resection via an endoscopic approach.
CONCLUSIONS
SLA-mediated thermal-coagulation is a potential strategy for minimizing hemorrhagic risks in brain tumor resection and may be used in conjunction with other approaches tailored to the patient and their disease.
Topics: Aged; Brain Neoplasms; Cerebral Hemorrhage; Female; Humans; Laser Therapy; Neuroendoscopy; Pineal Gland; Pinealoma; Proof of Concept Study
PubMed: 32360672
DOI: 10.1016/j.wneu.2020.04.125 -
Southern Medical Journal Oct 2010Germinomas are gonadal neoplasms that rarely occur extragonadally in the midline structures of the human body. Newly diagnosed adult cases of pineal gland germinomas are... (Review)
Review
Germinomas are gonadal neoplasms that rarely occur extragonadally in the midline structures of the human body. Newly diagnosed adult cases of pineal gland germinomas are very rare since most of the cases are diagnosed in the mid teens. The estimated incidence of this tumor in western countries is between 0.4-3.4%. Typically, this tumor is diagnosed by its characteristic radiological appearance alone, supported by tumor marker(s) or by stereotactic biopsy of the tumor. We are reporting a very unique case of pineal germinoma diagnosed in an adult at our institute by cerebrospinal fluid cytology with literature review. We analyzed case reports, literature reviews, and therapy and diagnostic articles about pineal germinoma in the English literature from 1983 to 2009 through the national library of medicine, Pubmed, and OVID search engines. We used key words "pineal germinoma," "pineal gland tumor," "CNS germinoma," and "extragonodal germinomas" to search for our articles.
Topics: Adult; Combined Modality Therapy; Germinoma; Humans; Magnetic Resonance Imaging; Male; Pinealoma; Pituitary Hormones; Prognosis; Tomography, X-Ray Computed
PubMed: 20818311
DOI: 10.1097/SMJ.0b013e3181ebeeff -
American Journal of Optometry and... Jul 1987A patient was admitted to the Emergency Department of the Montreal General Hospital and referred to the Ophthalmology Clinic. He reported disorientation, dizziness,...
A patient was admitted to the Emergency Department of the Montreal General Hospital and referred to the Ophthalmology Clinic. He reported disorientation, dizziness, frontal headaches, and near vision problems. He had reduced near vision, binocular vision anomalies, Collier's sign, and abnormal pupil sizes, shapes, and responses. A diagnosis of pinealoma with a poor prognosis due to metastases was made.
Topics: Brain Neoplasms; Diplopia; Humans; Male; Middle Aged; Nystagmus, Pathologic; Pain; Pinealoma; Prognosis
PubMed: 3631213
DOI: 10.1097/00006324-198707000-00011 -
Journal of Neuro-oncology Nov 2010Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of...
Given its rarity, appropriate treatment for pineocytoma remains variable. As the literature primarily contains case reports or studies involving a small series of patients, prognostic factors following treatment of pineocytoma remain unclear. We therefore compiled a systematic review of the literature concerning post-treatment outcomes for pineocytoma to better determine factors associated with overall survival among patients with pineocytoma. We performed a comprehensive search of the published English language literature to identify studies containing outcome data for patients undergoing treatment for pineocytoma. Kaplan-Meier analysis was utilized to determine overall survival rates. Our systematic review identified 168 total patients reported in 64 articles. Among these patients, 21% underwent biopsy, 38% underwent subtotal resection, 42% underwent gross total resection, and 29% underwent radiation therapy, either as mono- or adjuvant therapy. The 1 and 5 year overall survival rates for patients receiving gross total resection versus subtotal resection plus radiotherapy were 91 versus 88%, and 84 versus 17%, respectively. When compared to subtotal resection alone, subtotal resection plus radiation therapy did not offer a significant improvement in overall survival. Gross total resection is the most appropriate treatment for pineocytoma. The potential benefit of conventional radiotherapy for the treatment of these lesions is unproven, and little evidence supports its use at present.
Topics: Adolescent; Adult; Aged; Brain Neoplasms; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Neurosurgical Procedures; Pineal Gland; Pinealoma; Radiotherapy, Adjuvant; Treatment Outcome; Young Adult
PubMed: 20461445
DOI: 10.1007/s11060-010-0189-6 -
Acta Pathologica, Microbiologica, Et... May 1987Stereotactic biopsies were obtained from a tumor in the pineal gland of a 37 year old man. Histological and smear preparations were studied using conventional staining...
Stereotactic biopsies were obtained from a tumor in the pineal gland of a 37 year old man. Histological and smear preparations were studied using conventional staining techniques as well as immunocytochemical methods with monoclonal antibodies to glial fibrillary acidic protein (GFAP), the neurofilament proteins (NFP), the presynaptic vesicle protein synaptophysin as well as with antisera to neuronal specific enolase (NSE). The tumor was classified as a pineocytoma. The tumor cells uniformly contained no cytoplasmic GFAP but NFP, NSE and synaptophysin as shown by the immunocytochemical techniques. The pineocytoma could thus be subclassified as a pineocytoma with neuronal differentiation. The patient subsequently succumbed due to a hemorrhage into the tumor and autopsy confirmed the biopsy findings. We conclude that immunocytochemical techniques may prove invaluable in the subclassification of tumors of the pineal region.
Topics: Adult; Brain Neoplasms; Cytoplasm; Glial Fibrillary Acidic Protein; Humans; Immunoenzyme Techniques; Intermediate Filament Proteins; Male; Membrane Proteins; Neurofilament Proteins; Neurons; Phosphopyruvate Hydratase; Pinealoma; Synaptophysin
PubMed: 3111171
DOI: 10.1111/j.1699-0463.1987.tb00016_95a.x -
Neuroradiology Jul 2000We reviewed neuroradiological images in two histologically proven cases of pineocytoma and three of pineoblastoma to delineate the characteristic features of these rare...
We reviewed neuroradiological images in two histologically proven cases of pineocytoma and three of pineoblastoma to delineate the characteristic features of these rare tumours. CT revealed isodense or slightly hyperdense masses with central or peripheral calcification; enhancement with contrast medium tended to be homogeneous in pineocytomas and heterogeneous in pineoblastomas. In the pineocytomas, T1-weighted images revealed rounded, sometimes or slightly lobulated low-signal masses with strong, homogeneous contrast enhancement. Their margin was clear, without invasion of adjacent structures. In the pineoblastomas, however, T1-weighted images revealed multilobulated tumours with heterogeneous contrast enhancement. All three pineoblastomas had poorly defined margins with adjacent structures such as the posterior thalamus or corpus callosum, suggesting a more invasive nature. T2-weighted images revealed nonspecific high signal lesions in all five cases.
Topics: Adult; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Pineal Gland; Pinealoma; Tomography, X-Ray Computed
PubMed: 10952183
DOI: 10.1007/s002349900243 -
Neuro-Chirurgie 2015The pineal gland has interested humans from millenniums. In this paper we review back in the history and the evolution of the pineal gland surgery. Originally, this... (Review)
Review
The pineal gland has interested humans from millenniums. In this paper we review back in the history and the evolution of the pineal gland surgery. Originally, this surgery used to carry a high rate of morbidity and mortality. Nowadays the development of the anesthetic, radiological, surgical and intensive care techniques have been responsible of an improvement of the surgical results and better quality of life. It is always interesting to know from where we come.
Topics: Biopsy; Brain Neoplasms; History, 16th Century; History, 17th Century; History, 18th Century; History, 19th Century; History, Ancient; Humans; Neurosurgical Procedures; Pineal Gland; Pinealoma; Quality of Life
PubMed: 25016433
DOI: 10.1016/j.neuchi.2013.03.005 -
Neurologia Medico-chirurgica Dec 1993A 58-year-old female with pineocytoma developed intratumoral hemorrhage after ventriculoperitoneal shunting for hydrocephalus. Neurological examination revealed...
A 58-year-old female with pineocytoma developed intratumoral hemorrhage after ventriculoperitoneal shunting for hydrocephalus. Neurological examination revealed Parinaud's sign and papilledema. Computed tomography and magnetic resonance (MR) imaging revealed a pineal neoplasm and obstructive hydrocephalus. Serum and cerebrospinal fluid levels of human chorionic gonadotropin, alpha-fetoprotein, carcinoembryonic antigen, and placental alkaline phosphatase were negative or within normal limits. MR images after the ventriculoperitoneal shunting disclosed intratumoral hemorrhage and markedly smaller ventricles. The tumor was totally removed via the occipital transtentorial approach and was diagnosed histologically as a pineocytoma with astrocytic differentiation. The tumor probably shifted away from the surrounding structures following the marked reduction in ventricular size after ventriculoperitoneal shunting, resulting in changed venous circulation in the tumor and the formation of intratumoral hematoma.
Topics: Brain; Brain Neoplasms; Cerebral Hemorrhage; Female; Humans; Hydrocephalus; Magnetic Resonance Imaging; Middle Aged; Photomicrography; Pineal Gland; Pinealoma; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt
PubMed: 7512231
DOI: 10.2176/nmc.33.836 -
Operative Neurosurgery (Hagerstown, Md.) Jan 2021
Commentary: Virtual Reality Surgical Rehearsal and 2-Dimensional Operative Video of a Paramedian Supracerebellar Infratentorial Approach Endoscopic Resection of Pineocytoma: 2-Dimensional Operative Video.
Topics: Brain Neoplasms; Endoscopy; Humans; Pineal Gland; Pinealoma; Virtual Reality
PubMed: 33313864
DOI: 10.1093/ons/opaa377 -
Journal of Neuro-oncology Jan 1992From 1972-1985, 30 patients with pineal area tumor have been treated with combinations of surgery and irradiation, no patient receiving chemotherapy as a primary...
From 1972-1985, 30 patients with pineal area tumor have been treated with combinations of surgery and irradiation, no patient receiving chemotherapy as a primary recommendation. Patients ranged between 3 and 69 years of age, 18 were male and 12 female. In 18 patients a tissue diagnosis was made initially, 14 patients required shunts before definitive management and in 8 of the 14 tissue diagnosis was made at the same time. Eight patients had no surgical intervention at any time. Patients who have received irradiation have had whole brain irradiation, local field irradiation, or craniospinal irradiation. Two elderly patients died rapidly of their malignant processes before definitive treatment could be given. Only one patient with a non neoplastic lesion was seen. This was a bleed from an AVM with no underlying tumor. One patient with a pineocytoma was not irradiated. Overall, two-thirds of our patients are alive 5 to 15 years after treatment. There has been no surgical mortality and minimal morbidity from biopsy. Late effects of treatment include one patient with mild hearing loss and three patients with endocrinopathies amenable to medical treatment. We believe that tissue diagnosis allows optimal field design and dose recommendations to be made by the radiotherapist in addition to defining prognosis. In our experience, endodermal sinus tumor and pineoblastoma are highly malignant, and in view of their poor prognosis with conventional management consideration of more radical treatment with a possible role for chemotherapy is suggested.
Topics: Adolescent; Adult; Aged; Brain Neoplasms; Child; Child, Preschool; Female; Follow-Up Studies; Humans; Male; Middle Aged; Pineal Gland; Pinealoma; Retrospective Studies
PubMed: 1541982
DOI: 10.1007/BF00172460