Article
Microsurgical management of pineal region lesions via the supracerebellar infratentorial approach
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Authors
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Ludwig Benes
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
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Malgorzata Kolodziej
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
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Christoph Kappus
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
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Jochen Rohlfs
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
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Daniela Kuhnt
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
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Christopher Nimsky
- Klinik für Neurochirurgie, Universitätsklinikum Gießen und Marburg, Standort Marburg, Deutschland
| Published: | September 16, 2010 |
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Outline
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Objective: Microsurgical resection of pineal region lesions remains a challenging topic because of deeply located veins and eloquent mesencephalic structures.
The purpose of this study was to analyze this specific approach for the microsurgical resection of pineal region lesions in our consecutively treated patients.
Methods: From a total of 34 individuals with pineal region lesions treated in a 13-year-period (04/1997–02/2010), a retrospective chart review and video analysis was performed in 29 patients operated via the supracerebellar infratentorial approach. The microsurgical strategy was to localize the lesion in the pineal region and to circularly dissect the pathology from the deep venous and mesencephalic structures by interrupting tiny vessels entering the lesions. Surgery was assisted by cranial nerve monitoring, somatosensory evoked potentials and neuronavigation. Long-term follow-up included a neurological examination and magnetic resonance (MR) imaging studies. Statistical analyses were performed.
Results: Twelve males and seventeen females (mean age 29.8 yrs) with pineal lesions could be diagnosed. Eleven individuals suffered from a pineal cyst, 11 from a pineocytoma, 3 from an astrocytoma, 1 from a metastasis, 1 from an ependymoma, 1 from a papillary tumor of the pineal region (PTPR) and 1 from a pineal parenchyma tumor of intermediate differentiation (PPTID). Hydrocephalus occurred in 9 patients (31.0%). A median subocciptial incision was performed in all patients in a sitting position except for 2 (6.9%) individuals operated in prone position. Long-term follow-up was available for 23 patients (79.3%). Median follow-up was 20.2 months. Postoperative imaging was available in 28 patients (96.6%). Total removal of the lesion was achieved in 89.6% (n=26) individuals. Two patients (6.9%), both with malignant tumors had a permanent neurological deficit (parinaud syndrome), one patients died because of malignant tumor progression, the other patients (93.1%) were without neurological deficits, postoperatively.
Conclusions: The supracerebellar infratentorial approach provides an excellent exposure of the lesions located in the pineal region. Image-guided complete removal of these lesions assisted by electrophysiological monitoring can be accomplished with satisfying procedure related morbidity for the patients via this approach. Prior to surgery a meticulous evaluation of surgical anatomy is mandatory.
