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Operative Neurosurgery (Hagerstown, Md.) Dec 2020An endoscopic "keyhole" approach to a deep-lying skull base lesion can be a daunting challenge. For the pineal region, the techniques for endoscopic resection of solid...
Virtual Reality Surgical Rehearsal and 2-Dimensional Operative Video of a Paramedian Supracerebellar Infratentorial Approach Endoscopic Resection of Pineocytoma: 2-Dimensional Operative Video.
An endoscopic "keyhole" approach to a deep-lying skull base lesion can be a daunting challenge. For the pineal region, the techniques for endoscopic resection of solid tumors in this location are also new.1,2 In such a situation, surgical rehearsal in virtual reality (VR) can significantly improve the surgeon's confidence.3 In this operative video, we demonstrate the use of VR in surgical planning and rehearsal to determine the best approach to a large, solid pineal tumor in a 46-yr-old patient. Using the patient's computed tomography angiography and magnetic resonance imaging, a VR model of his anatomy was created (SNAP VR360 version 3.8.0, Surgical Theater Inc, Cleveland, Ohio). VR rehearsal showed that, with the tumor tucked under the corpus callosum and cradled by the internal cerebral veins and veins of Rosenthal, a supratentorial approach would be suboptimal. Because of the steep angle of the patient's tentorium in the midline, a classic supracerebellar infratentorial (SCIT) approach would be challenging, and thus a paramedian variant of SCIT was chosen.4 For a right-handed surgeon, the left side was used, and the endoscope was docked at the extreme left, out of the main surgical corridor. Shown in the video, the endoscopic resection achieved a complete resection. The histopathological diagnosis was a pineocytoma. No adjuvant treatment is recommended. Given the rarity of pineocytoma,5 the novelty of endoscopic resection of solid tumors in the region, and the challenge of "keyhole" approaches to deep-lying targets, VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure. Patient consent was obtained prior to the creation of the video and available on request. RHOTON images in the video are from The Rhoton Collection®.
Topics: Brain Neoplasms; Endoscopy; Humans; Pineal Gland; Pinealoma; Virtual Reality
PubMed: 32895715
DOI: 10.1093/ons/opaa270 -
Cancer Sep 1968
Topics: Adolescent; Adult; Child; Craniopharyngioma; Diabetes Insipidus; Female; Humans; Male; Pinealoma; Radiography; Vision Disorders
PubMed: 5673233
DOI: 10.1002/1097-0142(196809)22:3<533::aid-cncr2820220307>3.0.co;2-e -
Progress in Neurological Surgery 2009Pinea l parenchymal tumors (PPTs) are neuroepithelial tumors that arise from pineocytes or their precursors. According to the currently revised WHO classification of... (Review)
Review
Pinea l parenchymal tumors (PPTs) are neuroepithelial tumors that arise from pineocytes or their precursors. According to the currently revised WHO classification of tumors of the central nervous system, PPTs are subdivided into well-differentiated pineocytoma, poorly differentiated pineoblastoma, and PPT with intermediate differentiation (PPTID). Pineocytomas are slow-growing neoplasms composed of small mature cells resembling pineocytes. Large pineocytomatous rosettes are the most characteristic appearance. Pineoblastomas are the most primitive form and have a highly malignant biological behavior. PPTIDs show an intermediate histological grade of malignancy between pineocytomas and pineoblastomas. Immunohistochemically, PPTs are positive for several neuronal markers, including synaptophysin, neurofilaments, class III beta-tubulin, and chromogranin A. Photosensory differentiation is associated with immunoreactivity for retinal S-antigen and rhodopsin. Ultrastructurally, dense core vesicles and clear vesicles are present in both cytoplasm and cellular processes, the latter showing occasional synapse-like junctions. In some cases, ultrastructural evidence of photoreceptor differentiation, such as synaptic ribbons, microtubular sheaves, and cilia, is observed. Little is known about the genetics responsible for the development of PPTs. Several chromosomal abnormalities have been identified frequently in pineoblastomas and PPTIDs but less commonly in pineocytomas. Pineoblastomas are known to occur in patients with RB1 gene abnormalities, and these tumors also develop in patients with familial bilateral retinoblastomas (trilateral retinoblastoma syndrome). However, specific gene abnormalities involved in the tumorigenesis of PPTs have not been identified.
Topics: Brain Neoplasms; Humans; Pineal Gland; Pinealoma
PubMed: 19329858
DOI: 10.1159/000210050 -
Acta Neuropathologica 1986A pineocytoma was investigated by means of immunocytochemistry with the use of a polyclonal antibody against bovine retinal S-antigen. Several cells of this tumor...
A pineocytoma was investigated by means of immunocytochemistry with the use of a polyclonal antibody against bovine retinal S-antigen. Several cells of this tumor displayed strong S-antigen-like immunoreaction in analogy to certain pinealocytes in normal human pineal organs. This study indicates that S-antigen immunocytochemistry may be applied to characterize tumors of the pineal region.
Topics: Antigens; Antigens, Neoplasm; Arrestin; Brain Neoplasms; Humans; Immunoenzyme Techniques; Male; Middle Aged; Pineal Gland; Pinealoma
PubMed: 3515828
DOI: 10.1007/BF00687054 -
Child's Nervous System : ChNS :... Jun 2006Series of pinealoblastomas (PB) usually comprise small number of cases as this tumor type is extremely rare and occurs mainly in childhood (especially under 9 years of... (Clinical Trial)
Clinical Trial Comparative Study
INTRODUCTION
Series of pinealoblastomas (PB) usually comprise small number of cases as this tumor type is extremely rare and occurs mainly in childhood (especially under 9 years of age). Frequently, PB are reported together with others pineal parenchymal tumors (PPT) or pineal tumors, making characterization far from adequate.
MATERIALS AND METHODS
Our series of CNS pediatric tumors comprises 1,350 cases of whom 16 are PPT, 12 PB, two pineocytomas (PC), and two mixed or transitional tumors (PC/PB). We have only analyzed the PB considering clinical features, treatment strategy, prognosis, recurrences, and mortality.
RESULTS
PB represented 0.89%. Mean age was 7 years. Male-female ratio was 8/4. All patients complained of increased intracranial pressure, eight presented ocular symptoms, two cerebellar, and one endocrine disturbances. Patients underwent CT scans and/or MRI. All children had negative serum and CSF markers and only one case had positive tumor cells in the CSF on admission. Hydrocephalus (12/12) was treated with ventriculoperitoneal shunt in 11/12 and endoscopic third ventriculostomy (ETV) in 1/12. We performed 11 surgical procedures (seven by occipital transtentorial approach) and one endoscopic biopsy. Total removal was achieved in two, partial removal (50-90%) in seven, and biopsy in three patients or <50%. Adjuvant therapy included radiotherapy and chemotherapy. Recurrences appeared in 8/12 cases (mean time of recurrence=27.28 months). Six patients died (mean survival=29.55 months). Mean follow up for the six patients alive was 54 months and mean follow up for all 12 children was 38.7 months.
CONCLUSION
In our opinion, PB have a poor prognosis and are very aggressive, especially in small children. Survival rate at 1 and 5 years in the present series is 66.6% (8/12) and 50% (6/12), respectively. We propose an algorithm for the treatment of pediatric patients with PB.
Topics: Adolescent; Brain Neoplasms; Child; Child, Preschool; Female; Humans; Infant; Magnetic Resonance Imaging; Male; Pineal Gland; Pinealoma; Retrospective Studies; Ventriculoperitoneal Shunt
PubMed: 16555075
DOI: 10.1007/s00381-006-0095-6 -
Neurosurgery Mar 1979
Topics: Brain Neoplasms; Cerebral Hemorrhage; Humans; Male; Middle Aged; Pineal Gland; Pinealoma; Tomography, X-Ray Computed
PubMed: 460561
DOI: 10.1227/00006123-197903000-00015 -
Journal of Comparative Pathology 2011This report describes the first case of a pineocytoma in an 18-year-old female lowland anoa (Bubalus depressicornis). The tumour grossly appeared as a focal,...
This report describes the first case of a pineocytoma in an 18-year-old female lowland anoa (Bubalus depressicornis). The tumour grossly appeared as a focal, non-infiltrative, yellow-tan, encapsulated mass occupying the normal anatomical location of the pineal gland. Microscopical, immunohistochemical and electron microscopical findings were consistent with a diagnosis of pineocytoma an entity not previously described in this member of the buffalo subgenus species.
Topics: Animals; Animals, Zoo; Brain Neoplasms; Buffaloes; Fatal Outcome; Female; Immunohistochemistry; Microscopy; Pineal Gland; Pinealoma; Species Specificity
PubMed: 20961555
DOI: 10.1016/j.jcpa.2010.08.011 -
Neurosurgery Clinics of North America Jul 2011Intracranial GCTs are a heterogeneous group of neoplasms most commonly diagnosed in the pediatric population. Germinomas are exquisitely radiosensitive with long-term... (Review)
Review
Intracranial GCTs are a heterogeneous group of neoplasms most commonly diagnosed in the pediatric population. Germinomas are exquisitely radiosensitive with long-term survival rates in excess of 90% with radiotherapy alone. NGGCTs are associated with a poorer prognosis and are typically treated with a combination of radiation and chemotherapy. Given the young age of these patients, achieving optimal outcomes will ultimately require a careful balance of maximizing disease control while minimizing adverse treatment effects. Here we review the management of intracranial GCTs and discuss the clinical outcomes of patients who undergo treatment for these rare and fascinating tumors.
Topics: Chemoradiotherapy; Humans; Neoplasms, Germ Cell and Embryonal; Neurosurgical Procedures; Pinealoma; Radiation Dosage; Risk Assessment; Survival Rate
PubMed: 21801987
DOI: 10.1016/j.nec.2011.04.002 -
Current Treatment Options in Oncology Nov 2006Tumors of the pineal region represent a diverse collection of tumors with a variety of natural histories. This diversity necessitates accurate histologic diagnosis to... (Review)
Review
Tumors of the pineal region represent a diverse collection of tumors with a variety of natural histories. This diversity necessitates accurate histologic diagnosis to allow rational therapeutic planning. Evaluation of a pineal lesion should begin with craniospinal MRI and analysis of the cerebrospinal fluid (CSF). Whereas certainty of the histologic diagnosis is now a requirement for treatment in Western nations, some Asian centers continue to recommend a test dose of radiation therapy based on the high incidence of germinoma in those countries. If there is high clinical suspicion of a germinoma or tectal glioma, stereotactic or endoscopic biopsy may be pursued. All other lesions should be referred for open biopsy with microsurgical techniques. This approach provides adequate tissue for diagnosis, may be curative in low-grade tumors, and may substantially improve survival in patients with malignant tumors. If open surgery is not desired by the patient or practitioner, stereotactic or endoscopic biopsy may be followed by radiosurgery for localized, well-demarcated tumors. Radiation therapy is the first-line therapy for germinomas. Although the optimal radiation dosage and volume have not been decided, the current Children's Oncology Group trial may offer definitive evidence to address this dilemma in germ cell tumors. Evidence of CSF seeding requires craniospinal radiation and adjuvant chemotherapy regardless of tumor type. Diagnosis of any of the malignant tumors (non-germ cell tumors, pineoblastomas, and parenchymal tumors of intermediate determination) also requires craniospinal radiation (with local tumor doses of at least 50 Gy) and adjuvant chemotherapy (generally platinum based). Patients with tectal gliomas may undergo excision with or without postoperative radiation; however, they also may be observed with vigilant follow-up alone.
Topics: Brain Neoplasms; Combined Modality Therapy; Glioma; Humans; Magnetic Resonance Imaging; Neoplasms, Germ Cell and Embryonal; Pineal Gland; Pinealoma
PubMed: 17032562
DOI: 10.1007/s11864-006-0025-6 -
Acta Neuropathologica 1994Two pineal parenchymal tumors are presented, arising in a 54-year-old man and a 72-year-old woman; respectively. They showed isomorphic, cellular areas of small cells,...
Two pineal parenchymal tumors are presented, arising in a 54-year-old man and a 72-year-old woman; respectively. They showed isomorphic, cellular areas of small cells, often with characteristic pineocytomatous rosettes, and of medium-sized cells, as well as less cellular regions with highly pleomorphic, often ganglioid large cells. Immunohistochemistry disclosed extensive neuronal differentiation. There was intense positivity for neurofilament protein and microtubule-associated protein 2 in the pleomorphic areas and more variable expression in the isomorphic regions. Diffuse synaptophysin positivity was seen, accentuated along the borders of pleomorphic cells and in the rosettes, as well as diffuse interstitial and/or cytoplasmic expression of neuron-specific enolase, PGP 9.5 and tau. beta-Tubulin III was detected in most cells and slight positivity was found in the rosettes. Expression of glial fibrillary acidic protein, however, was restricted to resident astrocytes and an interstitial network of processes. These neuronally differentiated pleomorphic pineocytomas underline the broad histomorphological spectrum of pineal parenchymal tumors.
Topics: Aged; Brain Neoplasms; Female; Humans; Immunohistochemistry; Male; Middle Aged; Neurons; Pineal Gland; Pinealoma
PubMed: 7847074
DOI: 10.1007/BF00389497