P16.26 Surgical Treatment of Pineal Region Tumors

Abstract

Objective: To analyse short-term results and assess long-term follow-up of patients with pineal region tumors which were operated in Uzhhorod Regional Centre of Neurosurgery and Neurology. Methods: 24 patients with pineal region tumors were operated in Uzhhorod Regional Centre of Neurosurgery and Neurology since 2011. Male to female ratio was 1:1. Mean age of the patients was 25.2 years (10 were of paediatric age). Patients were divided into two groups according to tumor type: low-grade - 12 cases (meningioma - 3, pylocytic astrocytoma - 3, pineocytoma - 2, ependymoma - 1, choroid glioma - 1, papillary tumor - 1, xantogranulema - 1) and high-grade - 12 patients (pineoblastoma - 5, anaplastic astrocytoma - 2, glioblastoma -2, teratoma -1, germinoma - 1, choriocarcinoma - 1). The extent of resection was evaluated on early postoperative MRI. Short-term results were determined based on neurological examination one month after surgery in all patients. Long-term results were assessed based on overall survival in patients with high-grade tumors and Karnofsky Performance Scale (KPS) on last follow-up in patients with low-grade tumors. Mean follow up was 24 months (in low-grade group - 34 months). Results: Gross total resection was achieved in 10 cases (41.7%) and in 6 patients near total resection was performed (25%). 4 patients underwent a subtotal resection of the tumor (16.7%) and in 4 cases only partial resection was done (16.7%). Majority of the patients (83.3%) were neurologically stable or improved compared to preoperative status on day 30 follow-up. 2 patients (8.3%) deteriorated after resection of the tumor. Postoperative mortality was 8.3% (large venous infarction and postoperative meningitis). All patients with high-grade tumors underwent radio- and chemotherapy after surgery according to tumor histology. Mean overall survival in this group of patients was 11.6 months. 7 out of 12 patients (58.3%) with low-grade pineal tumors underwent gross total resection. On last follow-up 10 patients (83.3%) with low-grade tumors were KPS 100 and 2 (16.7%) patients were KPS 70. Conclusions: Resection of pineal region tumors is safe (morbidity/mortality - 16.6%). In patients with high-grade pineal tumors surgical strategy should consist of simple debunking as overall survival is poor (11.6 months). Excellent long-term outcome (KPS 100 in 83.3%) in patients with low-grade tumors was achieved with aggressive surgical strategy (gross total resection in 58.3%).