Treatments and Prognoses of Pineal Tumors

Experience of 110 Cases

Abstract

Treatments of 110 pineal tumors, which were experienced at the Department of Neurosurgery of Niigata University, are reviewed and evaluated. The 110 tumors included 74 germinomas (including germinomas arising in sites other than the pineal region), 11 teratomas, 11 teratoid tumors, 5 mixed teratoma or teratoblastoma and germinomas, 3 glial tumors and 3 tumors with the origin of the pineal parenchyma. Seventy-four intracranial germinomas were located as follows: in the pineal region, 45; suprasellar region, 14; pineal to suprasellar regions, 7; cerebral hemisphere, 3; hypothalamus, 2; periventricular region, 2; and periventricular region and subarachnoid space, 1.
For the differential diagnosis of pineal tumors, a cerebrospinal fluid cytology to detect the epitheloid cells of germinoma and CT scan were very useful and enabled the diagnosis of germinoma or teratoma without biopsy.
Follow-up study revealed that radiotherapy for germinomas brought about satisfactory results in the lengths of survival and morbidity, especially in the smaller germinomas. The larger germinomas showed a tendency to recur and seemed to require a larger field of irradiation. Prophylactic irradiation of the whole spinal axis did not seem to be necessary unless surgical intervention was employed.
Teratomas absolutely have an indication of direct operation and the operative procedures were well-correlated to operative morbidity.
The treatment of radioresistant pineal tumors of malignant nature such as teratoid tumors, glial tumors or tumors of the pineal parenchyma was difficult. Postoperative radiochemotherapy and immunotherapy are necessary for the treatment of these tumors.