Pineal region tumors arise in or around the pineal gland and are relatively uncommon.
The optimal treatment for patients with a pineal tumor depends upon the tumor subtype and may include surgical removal, radiation therapy and/or chemotherapy. Fortunately, for the majority of pineal tumors that warrant surgical biopsy or removal, they can be accessed via a minimally invasive keyhole endoscopic approach passing over the cerebellum. At the BTC, we have a large experience in these keyhole procedures.
By incorporating cutting edge technology and instrumentation with proven surgical experience, we make surgery safer, less invasive and more effective. Our neurosurgeons work closely with our radiation oncologists, neuro-oncologists and neuro-pathologists to design the optimal treatment plan that incorporates the latest in radiotherapy techniques and tumor biomarker studies.
Keyhole Brain Tumor
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The pineal gland lies deep within the brain and regulates circadian rhythm. Occasionally, tumors or cysts can arise from this gland which may require surgery, radiation or chemotherapy.
As these tumors grow, they can compress or invade surrounding brain structures, causing various neurological deficits. Due to their location to the fluid filled regions of the brain, the ventricles, they can also cause increased fluid build-up and intracranial pressure due to hydrocephalus. These lesions can range from benign cysts to malignant tumors.
Symptoms of these tumors/cysts can vary depending on their type and effect on the surrounding brain structures. Typical symptoms include headaches, particularly those that are worse lying down, coughing, or upon awakening.
Other findings include vision difficulties, double vision, concentration difficulties, memory impairment and altered states of consciousness.
As the treatment(s) of these lesions vary greatly on the diagnosis, numerous tests may be necessary prior to surgery. Typical imaging studies include magnetic resonance imaging (MRI) or computer tomography (CT) scans of the brain. Specific high resolution MRI sequences can further characterize these tumors or cysts. The cerebrospinal fluid (CSF) may need to be analyzed via a lumbar puncture (spinal tap).
In specific situations, surgical biopsy may be necessary prior to definitive therapy. The most common pineal region tumors requiring treatment include pineocytomas, pineoblastomas, germinomas, teratomas, astrocytomas, ependymomas, papillary tumors and occasionally pineal cysts.
In many cases, the pineal lesion may be a benign cyst that may be observed with serial MRIs. In certain scenarios with specific imaging and CSF findings, chemotherapy and/or stereotactic radiosurgery may be indicated. Most tumors, however, will require surgical debulking or resection. Given recent advances, this surgical approach is typically performed endoscopically using a high-definition surgical telescope through a small bony opening at the back of the head working above the cerebellum and below a dural structure called the tentorium.
Biopsies could also be performed endoscopically through the ventricles. In cases with hydrocephalus – fluid buildup – due to the tumor, endoscopic “bypass” of the fluid (endoscopic third ventriculostomy) or extracranial bypass (ventriculoperitoneal shunt) may be indicated. Occasionally, biopsies and “bypasses” can be performed in the same setting. In many cases, chemotherapy and/or fractionated stereotactic radiotherapy may still be necessary following surgery.