Abstract
BackgroundSurgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus. Considering higher sensitivity of germinoma to anti-tumor therapy, we explored emergency irradiation as non-invasive measure in this situation.MethodsData of 35 germinoma patients with symptomatic hydrocephalus who received emergency irradiation of 3.4 Gy/2f were studied retrospectively. The maximum width of frontal horn and the minimum width of trunk of corpus callosum (TCC) were measured to evaluate hydrocephalus changing. Besides, mean deviation (MD) of Humphrey perimetry was employed to evaluate visual field defect. Correlations between hydrocephalus changing and clinical factors, including age, percentage of tumor regression, radiographic re-evaluation interval, and serum beta-human chorionic gonadotropin (β-HCG) level, were analyzed.ResultsThe median maximum diameter and volume of pineal lesions was 27 mm (range 10–55 mm) and 6.5cm3 (range 0.4–74.1 cm3), respectively. At median 8 days after irradiation, the median percentage of tumor remission was 55% (range 10–100%). The median maximum width of FN and the median minimum width of TCC were 11.6 mm and 39.0 mm, and 8.0 mm and 31.4 mm, before and after irradiation, respectively. The improvement of both parameters reached significant level (p < 0.001). However, none clinical factor was found to have correlation with their improvement. In 14 patients with paired data of pre- and post-irradiation MD, its change did not reach the significant level for both eyes. All patients successfully received subsequent chemoradiotherapy without surgical intervention.ConclusionsEmergency irradiation of 3.4 Gy/2f was an effective non-invasive measure to relief hydrocephalus in pineal germinoma patients.
Highlights
Surgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus
In our hospital, emergency irradiation of 3.4 Gy/2f was employed in patients who were diagnosed as pineal gland germinoma with symptomatic hydrocephalus, which intend to avoid invasive procedure
The inclusion criteria were (1) age < 30 years; (2) primary lesion located in pineal gland region; (3) on magnetic resonance imaging, the lesion was isointense on T1-weighted images and enhanced homogeneously; (4) at least one of serum or cerebral spinal fluid (CSF) beta-human chorionic gonadotropin (β-HCG) was elevated mildly (5.0 IU/L < Beta-human chorionic gonadotropin (β-HCG) < 100 IU/L); and (5) emergency irradiation was administrated due to hydrocephalus
Summary
Surgical interventions including ventriculostomy and ventriculo-peritoneal shunt were usually administrated in pineal germ cell tumor patients with symptomatic hydrocephalus. IGCTs are segregated into germinomas and non-germinomatous germ cell tumors (NGGCTs) in Pineal gland is one of the most common involved area, which accounts for 50–60% of iGCTs in some reports [6]. IGCTs involving the pineal gland often cause increased intracranial pressure as a result of aqueduct obstruction and may cause Parinaud’s syndrome (vertical gaze palsy and a pseudo-Argyll-Robertson pupil) in up to 50% of cases [7]. In our hospital, emergency irradiation of 3.4 Gy/2f was employed in patients who were diagnosed as pineal gland germinoma with symptomatic hydrocephalus, which intend to avoid invasive procedure.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
