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Pineal Tumors





In the past, surgical exploration of the pineal gland was very hazardous.  More recently with the aid of the operating microscope and stereotactic techniques direct approach to these tumors has become relatively safe. 

A histologic diagnosis should be established whenever possible.

Stereotactic biopsy and third ventriculoscopy would now be regarded as standard of care.

Survival rate is better in biopsied patients. 



  • Does not appear to affect survival.
  • Can be associated with an increased risk of tumor dissemination (positive cytology and VP shunt).


Resection (Adjuvant)

  • Aim is to debulk large tumors prior to RT. 
  • Approach may be occipital transtentorial or suboccipital supracerebellar. 
  • There are concerns that debulking might be too hazardous and some surgeons may not feel that risks justify the benefits of resection.


Resection (Radical)

Used for mature teratoma, pineocytoma, meningioma and ependymoma.


Different surgical routes:

  • Interhemispheric via corpus callosum
  • Via dilated right lateral ventricle
  • Suboccipital, divide tentorium
  • Infratentorial - Supracerebellar (operate with the patient sitting.  Incise high occipital to C2.  Sample CSF for cytology and markers.  Use operating microscope).


Surgical Technique


Associated Hazards

Approach Taken

Stereotactic biopsy

Aids diagnosis of lesions of uncertain histology


Decrease intracranial pressure

Increased risk of tumor dissemination

Ventroperitoneal shunt

Resection (Adjuvant)

Debulk large tumors prior to radiotherapy

Concerns that this may be too hazardous

Depends on neurosurgeon and their experience in this area

Occipital transtentorial or suboccipital supracerebellar

Resection (Radical)

Used for:

  • mature teratomas
  • pineocytomas
  • meningiomas
  • ependymomas

Hazard of surgery itself

Intrahemispheric via corpus callosum

via dilated right lateral ventricle

Suboccipital, divide tentorium

Infratentorial, supracerebellar


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