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World Neurosurgery Dec 2017Tumors arising from the pineal region account for approximately 1% of intracranial neoplasms. We present a case of a previously healthy 5-year-old boy with an acute... (Review)
Review
BACKGROUND
Tumors arising from the pineal region account for approximately 1% of intracranial neoplasms. We present a case of a previously healthy 5-year-old boy with an acute onset of headache. A magnetic resonance imaging (MRI) scan showed a pineal mass with aqueduct compression. The patient was scheduled for tumor resection. An endoscopic third ventriculostomy was performed in advance for the treatment of hydrocephalus. Afterwards, MRI showed a relevant regression of the pineal mass without specific treatment. Consequently, surgery was cancelled and further MRI follow-up showed a regression of the mass and a constant tumor mass over a period of 30 months. Spontaneous regression of malignant tumors is a rare phenomenon with an incidence of 1 of 60,000-100,000 cases. Only a few cases with spontaneous regression of pineal tumors have been reported.
METHODS
We performed a systematic literature review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines on spontaneously regressing pineal lesions and found 13 cases in the literature.
RESULTS
Six hypotheses for explaining tumor regression were found, comprising treatment with steroids, effects of diagnostic irradiation, treatment of hydrocephalus, pineal apoplexy, surgical trauma, and immunologic mechanisms. None of these mechanisms was evidentiary. However, in all reported cases, some kind of treatment (e.g. treatment of hydrocephalus, application of steroids, and so on) has been performed before tumor regression.
CONCLUSIONS
The clinician has to bear in mind that regression of pineal tumors might be triggered by use of steroids, for example, and in cases of improvement of the patient's presenting symptoms, new MRI scans should be performed.
Topics: Brain Neoplasms; Cerebral Aqueduct; Child, Preschool; Consciousness Disorders; Diffusion Magnetic Resonance Imaging; Headache; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Neoplasm Regression, Spontaneous; Pineal Gland; Pinealoma; Ventriculostomy; Vomiting
PubMed: 28844909
DOI: 10.1016/j.wneu.2017.08.106 -
Journal of Psychosomatic Research Jul 2016Melatonin plays a major role in maintaining circadian rhythm. Previous studies showed that its secretion pattern and levels could be disturbed in persons with dementia,... (Review)
Review
OBJECTIVE
Melatonin plays a major role in maintaining circadian rhythm. Previous studies showed that its secretion pattern and levels could be disturbed in persons with dementia, psychiatric disorders, sleep disorders or with cancer. Also ageing is a factor that could alter melatonin levels, although previous research provides contradicting results. As melatonin supplementation is increasingly applied in older persons as sleep medication, it is important to know if melatonin levels decrease in healthy ageing and/or secretion patterns change. The objective of this study is to determine physiological levels and secretion patterns of melatonin in healthy older people.
METHODS
We performed a systematic review and searched PubMed and Embase for studies published between January 1st 1980 and October 5th 2015 that measured melatonin in healthy persons aged ≥65years.
RESULTS
Nineteen studies were retrieved. The number of participants ranged from 5 to 60 per study. Melatonin was mostly measured by radioimmunoassay (RIA) and the number of measurements per 24hours varied from 1 to 96. Sixteen studies showed a secretion pattern with a clear peak concentration, mostly at 0200h or 0300h. Maximum concentrations varied greatly from 11.2 to 91.3pgml(-1). Maximum melatonin level in studies with participants mean aged 65-70years was 49.3pgml(-1) and in studies with participants mean aged ≥75years 27.8pgml(-1), p-value <0.001.
CONCLUSION
Total melatonin production in 24hours seems not to change in healthy ageing, but the maximal nocturnal peak concentration of melatonin might decline. It is important to take this into account when prescribing melatonin supplementation to older people.
Topics: Aged; Aged, 80 and over; Aging; Circadian Rhythm; Dementia; Dietary Supplements; Female; Health Status; Humans; Male; Melatonin; Observational Studies as Topic; Sleep; Sleep Wake Disorders
PubMed: 27302542
DOI: 10.1016/j.jpsychores.2016.05.005 -
Journal of Ovarian Research Jun 2016Melatonin is an indolamine produced by the pineal gland and it can exert a potent antioxidant effect. Its free radical scavenger properties have been used to advantage... (Meta-Analysis)
Meta-Analysis Review
Melatonin is an indolamine produced by the pineal gland and it can exert a potent antioxidant effect. Its free radical scavenger properties have been used to advantage in different organ transplants in animal experiments. Several concentrations and administration pathways have been tested and melatonin has shown encouraging beneficial results in many transplants of organs such as the liver, lungs, heart, pancreas, and kidneys. The objective of the present study was to review the scientific literature regarding the use of melatonin in ovary transplantation. A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was carried out using the Cochrane and Pubmed databases and employing the terms 'melatonin' AND 'ovary' AND 'transplantation.' After analysis, 5 articles were extracted addressing melatonin use in ovary transplants and involving 503 animals. Melatonin enhanced various graft aspects like morphology, apoptosis, immunological reaction, revascularization, oxidative stress, and survival rate. Melatonin's antioxidative and antiapoptotic properties seemingly produce positive effects on ovarian graft activity. Despite the promising results, further studies in humans need to be conducted to consolidate its use, as ovary transplantation for fertility preservation is gradually being moved from the experimental stage to a clinical setting.
Topics: Animals; Antioxidants; Apoptosis; Female; Graft Survival; Humans; Melatonin; Neovascularization, Physiologic; Organ Transplantation; Ovary; Oxidative Stress
PubMed: 27287621
DOI: 10.1186/s13048-016-0245-8 -
World Neurosurgery Feb 2016Magnetic resonance imaging (MRI) is the imaging modality of choice for the clinical management of brain tumors, and the majority of scanners operate with static magnetic... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Magnetic resonance imaging (MRI) is the imaging modality of choice for the clinical management of brain tumors, and the majority of scanners operate with static magnetic field strengths of 1.5 or 3.0 Tesla (T). During the past decade, ultrahigh field (UHF) MRI has been investigated for its clinical applicability. This meta-analysis evaluates studies pertaining to the application of UHF MRI to patients with brain tumors.
METHODS
The authors performed a systematic review of the literature. Articles relating to application of UHF MRI to brain anatomy and brain tumors with living subjects were included. Studies were grouped into 1 of 3 categories based on area of focus: "Anatomical Structures Involved with Brain Tumors," "Tumor characterization," and "Treatment Monitoring." Comparison studies with extractable outcomes measure data were analyzed for performance of UHF MRI versus clinical field strengths (1.5 T and 3 T).
RESULTS
Twenty-four studies (361 subjects) met inclusion criteria. The field of study was heterogeneous and rigorous statistical analysis was not possible. Overall, 279 patients with brain tumors scanned at UHF MRI have been reported. Of these, glioma and glioblastoma multiforme are the most commonly studied lesions (38.9% and 24.4%, respectively). In comparison studies between UHF MRI and clinical field strengths, 24 of 51 patients had outcome measures that were better with UHF MRI, 17 of 24 were equivalent at both field strengths, and 9 were worse at UHF MRI. The most common causes of a worse performance were susceptibility artifacts and magnetic field inhomogeneities (3 of 9). Imaging of the pituitary gland, pineal gland veins, cranial nerves, and tumor microvasculature were all shown to be feasible.
CONCLUSIONS
UHF MRI shows promise to improve detection and characterization of brain tumors, preoperative planning for neurosurgical resection, and longitudinal monitoring of the effects of radiation and antibody-based therapies. Technical innovations are needed to overcome field inhomogeneity and susceptibility artifacts in certain regions of the skull. Finally, larger studies comparing 1.5 T, 3.0 T, and 7.0 T or greater will determine whether UHF MRI gains acceptance as a clinical standard.
Topics: Brain Neoplasms; Humans; Magnetic Resonance Imaging
PubMed: 26409071
DOI: 10.1016/j.wneu.2015.09.048 -
Neuro-Chirurgie 2015The sitting position for pineal tumour removal remains controversial as regards the number of potential complications despite good surgical conditions. (Review)
Review
INTRODUCTION
The sitting position for pineal tumour removal remains controversial as regards the number of potential complications despite good surgical conditions.
METHOD
A systematic review of the literature was conducted in order to record the most frequent complications observed in this position, their incidence and prevention.
RESULTS
Venous air embolism, hypotension, pneumocephalus, macroglossia, quadriplegia and nerve injuries are the most frequent complications observed. Their incidence can be dramatically decreased with an accurate anesthesiological and neurosurgical management.
CONCLUSION
In training teams, the sitting position remains the gold standard for pineal tumour removal.
Topics: Anesthetics; Embolism, Air; Humans; Intraoperative Complications; Monitoring, Intraoperative; Neurosurgical Procedures; Pineal Gland
PubMed: 25676910
DOI: 10.1016/j.neuchi.2014.10.110 -
The Lancet. Oncology Sep 2014About 5% of children with retinoblastoma from germline mutation of the RB1 gene are at risk of developing trilateral retinoblastoma--intraocular retinoblastoma combined... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
About 5% of children with retinoblastoma from germline mutation of the RB1 gene are at risk of developing trilateral retinoblastoma--intraocular retinoblastoma combined with a histologically similar brain tumour, most commonly in the pineal gland. We aimed to provide a systematic overview of published data for trilateral retinoblastoma, and to analyse how survival has changed.
METHODS
We searched Medline and Embase for scientific literature published between Jan 1, 1966, and April 14, 2014, that assessed trilateral retinoblastoma cases. We undertook a meta-analysis of survival with the Kaplan-Meier method and Cox proportional hazards regression, stratified on the basis of the original study, to account for between-study heterogeneity.
FINDINGS
We included 90 studies, with 174 patients with trilateral retinoblastoma. 5-year survival after pineal trilateral retinoblastoma increased from 6% (95% CI 2-15) in patients diagnosed before 1995, to 44% (26-61; p<0·0001) in those diagnosed from 1995 onwards. Before 1995, no patients with non-pineal trilateral retinoblastoma survived, but from 1995 onwards, 5-year survival was 57% (30-77; p=0·035). Hazard ratios (HR) adjusted for the presence of leptomeningeal metastases and trilateral retinoblastoma location, suggested that both conventional (HR 0·059, 95% CI 0·016-0·226; p<0·0001) and high-dose chemotherapy with stem-cell rescue (0·013, 0·002-0·064; p<0·0001) most strongly contributed to this improvement. Absence of leptomeningeal metastases (HR 2·13, 95% CI 0·98-4·60; p=0·055) were associated with improved survival. Non-pineal trilateral retinoblastomas were larger than pineal tumours (median 30 mm [range 6-100] vs 22 mm [7-60]; p=0·012), but both had similar outcomes since 1995.
INTERPRETATION
Our results suggest that improvements in overall survival are attributable to improved chemotherapy regimens and early detection of pineal trilateral retinoblastoma. As such, successful treatment of trilateral retinoblastoma should include screening at least at the time of retinoblastoma diagnosis and chemotherapy, which would preferably be a high-dose regimen with autologous stem-cell rescue.
FUNDING
None.
Topics: Antineoplastic Combined Chemotherapy Protocols; Child; Child, Preschool; Combined Modality Therapy; Disease-Free Survival; Early Detection of Cancer; Female; Hematopoietic Stem Cell Transplantation; Humans; Infant; Kaplan-Meier Estimate; Male; Pineal Gland; Prognosis; Proportional Hazards Models; Radiotherapy, Adjuvant; Retinal Neoplasms; Retinoblastoma; Risk Assessment; Survival Analysis; Treatment Outcome
PubMed: 25126964
DOI: 10.1016/S1470-2045(14)70336-5 -
Neuro-Chirurgie 2015The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic... (Review)
Review
OBJECTIVE
The natural history of pineal cysts still remains unclear. Incidental pineal cysts have become more common which raises the question of their management. Symptomatic pineal cysts may require a surgical solution but therapeutic indications have not yet been clearly established.
METHOD
From 1986 to 2012, 26 patients with pineal cysts were identified. Their medical records were retrospectively assessed focusing on the initial symptoms, imaging characteristics of the cyst, management strategy, operative technique and their complications, as well as the latest follow-up. A systematic review of the literature is also presented.
RESULTS
Twenty-six patients with pineal cysts were identified. The mean age was 23.5 years ranging from 7 to 49 years. Symptoms included intracranial hypertension with obstructive hydrocephalus in 18 cases and oculomotor anomalies in 12 cases. Two adult cases presented with non-specific headaches and did not require surgery. Twenty patients were operated via a suboccipital transtentorial approach with total removal of the cyst in 70% of the cases, while the remaining 4 cases were treated with an intraventricular endoscopic marsupialization associating a third ventriculostomy. Four patients required a preoperative ventriculo-peritoneal shunt due to life-threatening obstructive hydrocephalus. Overall, peri-operative mortality was nil. In the two non-operated patients, the cyst remained stable and no recurrences were observed in all operated patients with a mean follow-up of 144 months.
CONCLUSION
In the majority of incidental pineal cysts, a clinical and imaging follow-up is sufficient but occasionally not required especially in adults as very rare cases of increase in size have been reported.
Topics: Brain Neoplasms; Central Nervous System Cysts; Humans; Hydrocephalus; Neoplasm Recurrence, Local; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 24907165
DOI: 10.1016/j.neuchi.2013.08.010 -
Journal of Neurosurgery Aug 2010Pineocytoma is a rare tumor, and the current literature on these tumors is primarily composed of case reports and small case series. Thus, recommendations on appropriate... (Review)
Review
OBJECT
Pineocytoma is a rare tumor, and the current literature on these tumors is primarily composed of case reports and small case series. Thus, recommendations on appropriate treatment of these tumors are highly varied. Therefore, the authors performed a systematic review of the literature on tumor control after surgery for pineocytoma to determine the relative benefits of aggressive resection and postoperative adjuvant radiotherapy.
METHODS
A comprehensive search of the published English-language literature was performed to identify studies citing outcome data of patients undergoing surgery for pineocytoma. Determination of rates of progression-free survival (PFS) was performed using Kaplan-Meier analysis.
RESULTS
Sixty-four articles met the criteria of the established search protocol, which combined for a total of 166 patients. Twenty-one percent of these patients had undergone a biopsy procedure, 38% had undergone subtotal resection (STR), 42% had undergone gross-total resection, and 28% were treated with radiation therapy. The 1- and 5-year PFS rates for the resection group versus the biopsy group were 97 and 90% (1 year), and 89 and 75% (5 years), respectively (p < 0.05, log-rank test). The 1- and 5-year PFS rates for the GTR group versus the group undergoing STR combined with radiation therapy were 100 and 94% (1 year), and 100 and 84% (5 years), respectively (p < 0.05, log-rank test). There was no significant difference in PFS for STR only compared with STR in addition to radiation therapy.
CONCLUSIONS
Gross-total resection is the ideal treatment for pineocytoma and might represent a cure for these lesions. When gross-total resection is not possible, adjuvant radiation therapy after STR is of questionable benefit for these patients.
Topics: Brain Neoplasms; Combined Modality Therapy; Humans; Kaplan-Meier Estimate; Pineal Gland; Pinealoma; Radiotherapy, Adjuvant
PubMed: 20136388
DOI: 10.3171/2009.12.JNS091683 -
Reproductive Toxicology (Elmsford, N.Y.) Apr 2008The purpose of this systematic review is to access the current state of knowledge concerning the role for melatonin in human pregnancy. Melatonin is a neuroendocrine... (Review)
Review
The purpose of this systematic review is to access the current state of knowledge concerning the role for melatonin in human pregnancy. Melatonin is a neuroendocrine hormone secreted nightly by pineal gland and regulates biological rhythms. The nighttime serum concentration of melatonin shows an incremental change toward the end of pregnancy. This small lipophilic indoleamine crosses the placenta freely without being altered. Maternal melatonin enters the fetal circulation with ease providing photoperiodic information to the fetus. Melatonin works in a variety of ways as a circadian rhythm modulator, endocrine modulator, immunomodulator, direct free radical scavenger and indirect antioxidant and cytoprotective agent in human pregnancy, and it appears to be essential for successful pregnancy. It also seems to be involved in correcting the pathophysiology of complications during pregnancy including those due to abortion, pre-eclampsia and fetal brain damage. The scientific evidence supporting a role for melatonin in human pregnancy is summarized.
Topics: Abortion, Spontaneous; Circadian Rhythm; Female; Fetal Development; Fetal Hypoxia; Humans; Maternal-Fetal Exchange; Melatonin; Parturition; Pre-Eclampsia; Pregnancy
PubMed: 18485664
DOI: 10.1016/j.reprotox.2008.03.005 -
Biological Research For Nursing Jul 2007Dysfunction in menstrual physiology has pronounced effects on quality of life, involving mood changes, body image, infertility, and pregnancy complications. Light... (Review)
Review
Dysfunction in menstrual physiology has pronounced effects on quality of life, involving mood changes, body image, infertility, and pregnancy complications. Light exposure may affect menstrual cycles and symptoms through the influence of melatonin secretion. The purpose of this systematic review is to determine the current state of knowledge about the effects of light and melatonin secretion on menstrual phase and cycle alterations. A brief overview of the influence of melatonin on human physiology is included. There is evidence of a relationship between light exposure and melatonin secretion and irregular menstrual cycles, menstrual cycle symptoms, and disordered ovarian function. In women with a psychopathology such as bipolar disorder or an endocrinopathy such as polycystic ovary syndrome, there seems to be greater vulnerability to the influence of light-dark exposure. Research on the complex role of light-dark exposure in menstrual physiology has implications for treatment of menstrual-associated disorders.
Topics: Chronobiology Disorders; Circadian Rhythm; Clinical Nursing Research; Depression; Female; Follicle Stimulating Hormone; Humans; Light; Luteinizing Hormone; Melatonin; Menstrual Cycle; Menstruation Disturbances; Ovary; Phototherapy; Pineal Gland; Pituitary Gland; Prolactin; Research Design; Risk Factors; Seasons
PubMed: 17601857
DOI: 10.1177/1099800407303337