Pineal Region Mass Research Articles

Blindness due to the third eye: Sudden visual loss in pineal gland tumor

We report a rare case of sudden visual loss in a 9-year-old child with a pineal gland tumor. At presentation, examination revealed nil light perception in both eyes, features suggestive of Parinaud’s syndrome and one-and-a-half syndrome, and a normal fundus. Neuroimaging revealed a pineal region mass compressing the midbrain, aqueduct of Sylvius, and third ventricle, with the latter being displaced anteriorly. The patient underwent ventriculoperitoneal shunting, after which the visual perception recovered and was followed by mass excision. Although the mechanism of brainstem symptoms is typical, pineal gland tumors are not a known cause of sudden vision loss.

SNO-EANO-EURACAN consensus on management of pineal parenchymal tumors.

Pineal parenchymal tumors are rare neoplasms for which evidence-based treatment recommendations are lacking. These tumors vary in biology, clinical characteristics, and prognosis, requiring treatment that ranges from surgical resection alone to intensive multimodal antineoplastic therapy. Recently, international collaborative studies have shed light on the genomic landscape of these tumors, leading to refinement in molecular-based disease classification in the 5th edition of the World Health Organization (WHO) classification of tumors of the central nervous system. In this review, we summarize the literature on diagnostic and therapeutic approaches, and suggest pragmatic recommendations for the clinical management of patients presenting with intrinsic pineal region masses including parenchymal tumors (pineocytoma, pineal parenchymal tumor of intermediate differentiation, and pineoblastoma), pineal cyst, and papillary tumors of the pineal region.

GCT-27. Β-HCG STIMULATION WITH RAPIDLY PROGRESSIVE PUBERTY (PP) IN INTRACRANIAL NON-GERMINOMATOUS GCT (NGGCT): CASE REPORT

Abstract BACKGROUND Intracranial non-germinomatous are rare heterogenous group of Central Nervous System (CNS) tumors that consist of embryonal carcinomas, yolk sac tumors, choriocarcinomas, and teratomas (mature, immature), with or without malignant transformation, as well as mixed types. Presentation frequently includes endocrinopathies, visual changes and signs of raised intracranial pressure. CASE We present a 9-year-old boy with history of headaches, voice changes, increased height and muscle mass, and new onset pubic hair for one month. Examination showed mild papilledema with no cranial nerve palsies, advanced linear growth with height velocity of 15.8 cm/yr with height and weight at 94th and 85th percentile respectively for age. Tanner 2 pubic hair, muscular body habitus and testicles volume of 10-12mLs bilaterally. MRI brain showed a localized pineal region mass with obstructive hydrocephalus. Tumor markers were elevated in serum (β-hCG;69 IU/l and AFP;36.8 ng/ml) with high CSF β-hCG of 41 IU/l with AFP <10ng/ml. Work up for advanced puberty showed bone age of 11.3yrs. Markedly elevated testosterone levels at 929 ng/dl with free testosterone of 135 pg/m. Both LH and FSH were undetectable supporting the diagnosis of peripheral non-gonadotropic puberty (PP). Diagnosis of NGGCT was established on biopsy. He received therapy with chemotherapy, second look surgery and radiation. He remains in remission (negative tumors markers and MRI). Interestingly initiation of therapy resulted in age-appropriate testosterone level and slowing down of rapidly progressive puberty clinically. CONCLUSION We herein present a rare association of β-hCG secreted by NGGCT that cross-reacts with testicular and adrenal LH receptors resulting in increased testosterone levels and rapidly progressive or precocious puberty in males. The incidence of PP in pineal NGGCT remains unknown with very few cases reported in the literature however these are an important consideration in children with advanced puberty in the absence of exogenous hormone exposure and or non-CNS etiologies.

A Pineal Parenchymal Tumor of Intermediate Differentiation in an Octogenarian Contains a Rare KBTBD4 Insertion.

Pineal parenchymal tumors are rare central nervous system tumors that pose diagnostic challenges for surgical pathologists. Due to their paucity, their clinicopathologic features are still being defined. We report an 86-year-old woman with a remote history of breast lobular carcinoma who presented with a 2-month neurologic history that included gait instability, blurry vision, and headaches. Magnetic resonance imaging revealed a lobular, heterogeneously enhancing pineal region mass compressing the aqueduct of Sylvius. A biopsy performed concomitant with endoscopic third ventriculostomy consisted of small sheets of cells with eosinophilic to clear cytoplasm, multipolar processes, and ovoid nuclei with stippled chromatin. Whole exome sequencing revealed a small in-frame insertion (duplication) in exon 4 of KBTBD4 (c.931_939dup, p.P311_R313dup/ p.R313_M314insPRR), which has very recently been reported in 2 pineal parenchymal tumors of intermediate differentiation (PPTID). Additionally, variants of uncertain significance in CEBPA (c.863G > C, p.R288P) and MYC (c.655T > C, p.S219P) were identified. Although PPTID is considered a disease of young adulthood, review of 2 institutional cohorts of patients with pineal region tumors revealed that 25% of individuals with PPTID were over 65 years of age. In conclusion, PPTID should be considered in the differential diagnosis of pineal region tumors in older adults.

Pediatric pineal region masses: a single-center experience over 25years.

Pineal region tumors (PRT) represent less than 1% of brain neoplasms. The rare and heterogeneous nature of these tumors is reflected in the variety of treatment modalities employed. A single-center retrospective review of all pediatric patients with pineal region tumors between November 1996 and June 2021 was performed. Fifty-six cases of pineal tumors were reviewed for age and symptoms upon presentation, diagnostic methods, imaging characteristics, histological classification, treatment modalities, recurrence, and mortality rates. The average age at diagnosis was 11.3years. The majority of patients were male (82.1%) and Caucasian (73.2%). The most common presenting symptoms were headache (n = 38, 67.9%) and visual problems (n = 34, 60.7%). Hydrocephalus was present in 49 patients (87.5%). Germinoma (n = 20, 35.7%) and non-germinomatous germ cell tumor (NGGCT) (n = 17, 30.4%) were the most common tumors. Chemotherapy was employed for 54 patients (96.4%), radiation for 49 (87.5%), and surgical resection for 14 (25.0%). The average duration of treatment was 5.9months. Progression-free survival was 74.4% at 5years and 72.0% at 10years. Overall survival was 85.7% at 5years and 77.1% at 10years. Treatment of pineal region tumors must be targeted to each patient based on presentation, subtype, presence of hydrocephalus, and extent of disease. Upfront surgical resection is usually not indicated. As advances in oncological care proceed, treatment modalities may continue to improve in efficacy.

De-differentiated metastatic adenosquamous carcinoma arising from germ cell tumor in the brain and spine.

Intracranial germ cell tumors have an estimated incidence of 0.4-3.4% in the Western Hemisphere. Patients can present with a variety of differing clinical signs and symptoms including headache, nausea/vomiting, hydrocephalus, obtundation, pyramidal tract signs, ataxia, and hypothalamic/pituitary dysfunction. Rarely germ cell tumors can transform into alternative malignancy. In these cases, treatment options may be difficult. Metastasis to the brain is not uncommon in germ cell tumors and is frequently reported within the pineal region; however, they are less common intraventricularly, within the posterior fossa and have never been reported after malignant transformation. Herein, we present the first reported case of a metastatic adenosquamous carcinoma transformed from a yolk sac tumor with diffuse cerebral metastasis in atypical locations of the brain including intraventricular and posterior fossa. A 53-year-old right-handed Caucasian female was transferred from an outside hospital for a chief complaint of altered mental status with CT head showing right side intraventricular mass and cerebellar hemorrhage. MRI of the brain found multifocal contrast-enhancing lesions of the right lateral ventricle, right cerebellum, right frontal lobe, diffuse lumbar dural enhancement, and an intramedullary lesion at the cervico-medullary junction of the brainstem. The right lateral ventricular lesion and right cerebellar lesions were resected. Pathology findings support a diagnosis of adenosquamous carcinoma, and the morphologic and immunophenotypic features suggest development as a somatic malignancy in a germ cell neoplasm with features of a yolk sac tumor. Germ cell tumors are typically included within the differential of pineal region masses; however, other locations such as intraventricular and posterior fossa are rarely seen. Even rarer are cases with malignant transformation to an alternative lesion for which treatment options are exceptionally scarce. Neurosurgeons and oncologists alike should be aware of this rare possible lesion to add to a broad differential diagnosis.

Pineal Gland Tumors: A Review.

Simple SummaryPineal neoplasms are tumors with different and variable morphological, histological, and radiological characteristics and, consequently different diagnosis and management. Due to their rarity, pineal tumors may be misdiagnosed. Pineal tumors, are divided into germ cell tumors, pineal parenchymal tumors and tumors that derive from adjacent structures. In this review, we report the clinical relevance of the main pineal gland tumors, underlining the importance of studying the triggering causes of pineal region carcinogenesis, to realize appropriate diagnosis and, consequently, better clinical management.The pineal gland is a small, pinecone-shaped endocrine gland that participates in the biological rhythm regulation of vertebrates. The recognized major product of the pineal gland is melatonin—a multifunctional endogenous indoleamine. Accumulating evidence suggests that the pineal gland is important for preserving ideal health conditions in vertebrate. Tumors of the pineal region account for approximately 3–11% of pediatric brain neoplasms but fewer than 1% of brain neoplasms in adults. It is fundamental to expand advanced imaging techniques together with both clinical and laboratory knowledge, to help to differentiate among pineal neoplasms and thus facilitate accurate primary diagnoses and proper therapeutic interventions. In this review, we report the gross anatomy of the pineal gland and its functional significance and discuss the clinical relevance of pineal gland tumors, underlining the importance of identifying the leading causes of pineal region masses.

Co-Occurrence of Pineal-Region and Pituitary-Stalk Hemangioblastomas in a Patient Presenting with Von Hippel-Lindau Disease – A Case Report

Abstract Introduction Hemangioblastomas of the pineal region or pituitary stalk are extremely rare. Only two cases of hemangioblastomas involving the pineal region have been reported, and four involving the pituitary stalk. The purpose of the present manuscript is to describe an unusual case of supposed hemangioblastoma found concomitantly in the pineal region and pituitary stalk of a patient diagnosed with Von Hippel-Lindau (VHL) disease. Case Report A 35-year-old female patient with a previous diagnosis of VHL complaining of occipital headaches and balance disturbances for three weeks, who previously had a cerebellar hemangioblastoma resected. The visual characteristics of the tumor suggested a friable vascular lesion with a reddish-brown surface, and an incisional biopsy was performed. The tumor consisted of a dense vascular network surrounded by fibrous stroma abundant in reticulin and composed by both fusiform and dispersed xanthomatous cells; the immunohistochemistry was immunopositive for neuron-specific enolase and immunonegative for epithelial membranous antigen. The patient has been monitored closely for 2 years, and the supratentorial masses have not presented any volume alteration. Conclusion This rare association must be taken into account in patients with VHL disease, or at least be suspected in patients who present a thickening of the pituitary stalk and a pineal-region mass. We believe a biopsy of our asymptomatic patient could have been dangerous due to inherent complications like intraoperative bleeding. We recommend close observation of asymptomatic lesions with MRIs every six months or until the lesions become symptomatic. If the pineal-region tumor does become symptomatic, gross resection via a transcallosal approach would be ideal.

NCOG-57. NEUROPSYCHOLOGICAL FUNCTION IN MENINGEAL MELANOCYTOMA: A CASE REPORT

Abstract Meningeal melanocytomas are rare tumors derived from leptomeningeal melanocytes. The aggressive subtype is considered a rare variant of malignant melanoma, carrying a poor prognosis. To date, the extant literature is void of any studies that have systematically assessed cognition or neuropsychological function in these patients. We present a case report of a 61-year-old male, right-hand dominant, Caucasian male with 16 years of formal education. He has an unremarkable medical history, and his presenting symptom were syncopal episodes. An extensive work-up revealed a complex pineal region mass. Serum markers (CEA, AFP, and beta HcG) were negative. The patient continued to deteriorate neurologically and underwent a gross total resection of the mass. At the time of resection, there was evidence of definitive leptomeningeal dissemination. Because of the leptomeningeal spread, he underwent whole brain radiation therapy with a boost to the cerebellum and surgical site. He subsequently required implantation of a ventriculoperitoneal shunt for treatment of communicating hydrocephalus. Prior to WBRT, the patient underwent comprehensive neuropsychological testing. According to the patient and his spouse, they estimated functioning at approximately 50% of normal cognition, with precipitous decline noted prior to resection of the lesion. At the time of the exam, he was dependent in essentially all instrumental activities of daily living. The examination identified a pattern consistent with diffuse subcortical involvement, characterized by impairments in cognitive processing speed, attention, working memory and executive function. Conversely, the patient demonstrated no amnesia or higher cortical dysfunction. Moreover, mood, anxiety, or other psychopathology failed to account for his cognitive impairment. In our review, this is the first case in the literature of a patient with meningeal melanocytoma (with leptomeningeal spread) who has been comprehensively assessed neuropsychologically. Conceptualizations, treatment, and prognosis will be discussed.

One- vs Two-Burr-Hole Technique for Combined Endoscopic Third Ventriculostomy and Pineal Region Biopsy: Volumetric Analysis of Brain at Risk.

Pineal region tumors are associated with the ventricular system. Endoscopic third ventriculostomy (ETV) is often performed at the same time as tumor biopsy. To investigate the volume of brain possibly undergoing injury and forniceal stretching during ETV and tumor biopsy. We performed a retrospective review of preoperative magnetic resonance imagings (MRIs) and computed tomography (CTs) of patients with pineal region masses and used volumetric image-guided navigation to simulate a 1-burr-hole vs a 2-burr-hole approach through the brain parenchyma. We compared the volumes of parenchyma and fornix at the risk of injury. The ideal entry point for ETV using 2 burr holes was a mean±standard deviation (SD) of 25.8±6 mm from the midline and 11.4±9 mm behind the coronal suture. The ideal entry point using 2 burr holes for tumor biopsy was 25.7±8 mm from the midline and 53.7±14 mm anterior to the coronal suture. With 1 burr hole, the mean±SD volume of brain parenchyma at risk was 852±440 mm3. The volume of brain parenchyma at risk with 2 burr holes was 2159±474 mm3 (P<.001; paired t-test). The use of 1 burr hole predisposed the fornix to 14±3 mm of possible stretch, which was minimized with the 2-burr-hole approach. Using 1 burr hole for both the ETV and tumor biopsy is less likely to traumatize the brain parenchyma than using 2 burr holes. However, 1 burr hole predisposes the fornix to stretch injury. We recommend tailoring the entry to each patient according to their anatomy rather than using a 1-size-fits-all approach.

Biomarkers of Pineal Region Tumors: A Review.

Background: The pineal gland, a small, pinecone-shaped organ deep within the brain, is responsible for producing melatonin. The gland consists of pineal parenchymal cells and glial cells that can form neoplasms. Pineal region neoplasms can also arise from germ cells and adjacent structures. This review focuses on detection of serum and cerebrospinal fluid (CSF) biomarkers of germ cell tumors and pineal parenchymal cell tumors, as these types comprise most neoplasms specific to the pineal region. Methods: For this review, we searched PubMed using the following keywords: biomarkers, germ cell tumor, germinoma, melatonin, pineal, pineal gland, pineal neoplasm, pinealoma, pineal parenchymal cell tumor, pineal region, and pineal tumor. We limited our search to full-text English articles and identified other relevant sources from the reference lists of identified articles. Results: Serum and CSF biomarker assays have a role in cases of suspected pineal germ cell or parenchymal neoplasms. Biomarkers including alpha-fetoprotein, beta-human chorionic gonadotropin, and placental alkaline phosphatase inform diagnosis and treatment and are important for monitoring germ cell tumor response to treatment. No biomarkers are currently available that inform diagnosis or treatment of pineal parenchymal tumors, although melatonin assays may have a role in monitoring response to treatment. Conclusion: Serum and CSF biomarkers in conjunction with clinical and radiographic evidence of a pineal region mass can inform the decision whether to undertake stereotactic biopsy or surgical excision or whether to proceed straight to medical treatment.

Ventriculocisternal Shunt Redivivus: Third Ventricle–Cisterna Magna Intradural Shunt: A Technical Note and Case Report

To present a hitherto unreported modification of the classic Torkildsen procedure: passing a catheter intracranially, between the third ventricle and cisterna magna. We applied our technique to a 56-year-old man who presented to our department for treatment of a pineal region mass. The patient was placed in sitting position and the mass was gross totally removed through a supracerebellar infratentorial approach. After the completion of the tumor resection, the patency of the cerebral aqueduct was checked, but the permeability was doubtful. During the same procedure, a shunt was inserted, under direct microsurgical control, into the third ventricle and passed over the cerebellar surface into the cisterna magna. The postoperative course was uneventful, and the patient was discharged from our unit with no neurological deficits and able to carry on with his day-to-day life. Our case illustrates that ventriculocisternal shunting can successfully be used in selected cases. The variation we describe can be a valuable surgical strategy in patients with pineal region masses, in whom a supracerebellar infratentorial route is used and in whom uncertainty exists regarding the patency of the sylvian aqueduct.

Clinicopathologic features and pathogenesis of melanocytic colonization in atypical meningioma

Only two prior cases of benign dendritic melanocytes colonizing a meningioma have been reported. We add a third case, describe clinicopathologic features shared by the three, and elucidate the risk factors for this very rare phenomenon. A 29 year-old Hispanic woman presented with headache and hydrocephalus. MRI showed a lobulated enhancing pineal region mass measuring 41 mm in greatest dimension. Subtotal resection of the mass demonstrated an atypical meningioma, WHO grade II, and the patient subsequently underwent radiotherapy. She presented 4 years later with diplopia, and MRI showed an enhancing extra-axial mass measuring 47 mm in greatest dimension and centered on the tentorial incisura. Subtotal resection showed a brain-invasive atypical meningioma with melanocytic colonization. The previous two cases in the literature were atypical meningiomas, one of which was also brain invasive. Atypical meningiomas may be at particular risk for melanocytic colonization as they upregulate molecules known to be chemoattractants for melanocytes. We detected c-Kit expression in a minority of the melanocytes as well as stem cell factor and basic fibroblast growth factor in the meningioma cells, suggesting that mechanisms implicated in normal melanocyte migration may be involved. In some cases, brain invasion with disruption of the leptomeningeal barrier may also facilitate migration from the subarachnoid space into the tumor. Whether there is low-level proliferation of the dendritic melanocytes is unclear. Given that all three patients were non-Caucasian, meningiomas in persons and/or brain regions with increased dendritic melanocytes may predispose to colonization. The age range spanned from 6 years old to 70 years old. All three patients were female. The role of gender and estrogen in the pathogenesis of this entity remains to be clarified. Whether melanocytic colonization may also occur in the more common Grade I meningiomas awaits identification of additional cases.

Imaging Spectrum of Unusual Pineal Region Masses: A Short Series of Four Cases

AbstractPineal tumors are rare intracranial neoplasm with germ cell tumors and pineal parenchymal tumors being the predominant type, seen in 80 to 90% of cases. Only a few cases of glioblastomas have been reported. The incidence of astrocytoma and meningioma is also low in this region. In this article, we will discuss the key imaging features and diagnostic dilemmas in four rare types of pineal region tumors including pineal parenchymal tumor of intermediate differentiation, pineal astrocytoma, falcotentorial junction meningioma, and glioblastoma with subependymal spread.

Pineal Region Masses in Pediatric Patients.

A review of pediatric pineal region tumors is provided with emphasis on advanced imaging techniques. The 3 major categories of pineal region tumors include germ cell tumors, pineal parenchymal tumors, and tumors arising from adjacent structures such as tectal astrocytomas. The clinical presentation, biochemical markers, and imaging of these types of tumors are reviewed.

Our Experience with Infratentorial Supracerebellar (ITSC) Approach for Pineal Region Tumor Excision

Pineal region tumors are rare and their incidence is less than 1% of primary CNS tumors. Varieties of tumors can be found in pineal region ranging from benign to malignant pathology. Treatment modalities ranged from biopsy to total excision of tumor. Many surgical approaches have been described in the literature, however, infratentorial supracerebellar ( ITSC ) approach is versatile and widely used by many neurosurgeons worldwide.The aim of this study is to analyze and discuss the surgical outcome of pineal region tumor using ITSC approach. Advantages and limitations of this approach will be discussed.This is a retrospective study of 10 patients who underwent microsurgical excision of pineal region masses using ITSC approach in sitting position under general anesthesia at our institute between April 2009 and March 2014. The follow up period ranged from 7 months to 5 years and outcome was measured with GOS (Glasgow Outcome Scale).There were 9 male and 1 female and age ranged from 10 to 50 years.Gross total resection was performed in all 10 cases using ITSC approach. 9 patients required VP shunt for obstructive hydrocephalus. 60% (6) had benign and 40% (4) had malignant pathology.Six patients suffered from postoperative complications which included air embolism ,pneumocephalus, pseudomeningocele and seizure.Eighty percent (8) have good recovery, 1 was severely disabled and 1 died.Advanced neurological techniques combined with neuroanesthesia, neuroimaging and postoperative critical care methods have made aggressive surgical resection a mainstay of management of pineal region tumors with excellent results.Nepal Journal of Neuroscience 12:31-37, 2015

Primary intracranial germ cell tumors: A single institution experience from a South Indian tertiary cancer center

Background: Intracranial germ cell tumors (ICGCTs) are rare tumors seen in the pineal and suprasellar regions. The World Health Organization has classified ICGCTs into germinoma and nongerminomatous GCT (NGGCT). Germinoma is radiosensitive and has excellent survival rate. Patients with NGGCTs are less sensitive to radiotherapy and have less favorable outcome. Objective: This retrospective observational study was carried out to determine the clinical features, treatment, and outcome of patients diagnosed as ICGCT from June 2006 to June 2014.Materials and Methods: Patients' medical records were reviewed for information regarding age, gender, presenting features, treatment instituted, complications, and treatment outcome. Results: Seven patients with ICGCT were studied. Their age ranged from 4 to 24 years, with median age being 13 years. All of them were male. Four patients had germinoma and three had mixed NGGCT. Four patients had pineal region mass, two patients had suprasellar mass, and one patient had bifocal disease with both pineal and suprasellar involvements. Following surgical debulking or ventriculoperitoneal shunt, patients received radiation and chemotherapy. One patient of germinoma and another patient of NGGCT died due to febrile neutropenia/sepsis. The overall survival was 4 years for patients with both germinoma and NGGCT. Conclusions: ICGCTs are rare tumors seen in the second decade of life, with male preponderance. With judicious use of chemotherapy and radiotherapy, germinoma has excellent survival outcome. The outcome of NGGCT can be improved with multimodality treatment.

Complete regression of adult pineoblastoma following radiotherapy: A case report and review of the literature.

Adult pineoblastomas (PBs) are rare central nervous system tumors. Little is known with regard to the clinical features and outcomes of adult PB, and optimal treatment strategies for adult PB remain to be determined. The current report describes a case of PB in a 46-year-old male, who presented with obstructive hydrocephalus due to a large pineal region mass. Considering the potential effect on quality of life, the patient underwent a partial resection. Postoperative radiotherapy, comprising prophylactic craniospinal irradiation at a dose of 34.2 Gy followed by a local 25.3-Gy 'boost' to the tumor site for a total dose of 59.5 Gy, resulted in the complete regression of the tumor without neurological deficits. The patient has remained free of recurrence for 36 months after radiotherapy. This case highlights a minimally invasive strategy to treat a rare pineal region tumor with significant involvement of critical structures that resulted in a favorable response and an excellent neurological outcome. The radiographic and histopathological features of PB are also reviewed, and the various treatment options reported in the literature are discussed.

Clinical experience with a high definition exoscope system for surgery of pineal region lesions

VITOM-90 (Karl Storz Endoscopy, Tuttlingen, Germany) is a new technology that can be used as an alternative to the operating microscope. We have found that this device substantially improves surgeon comfort during infra-tentorial supracerebellar approaches to pineal region masses, and now report our experiences. The VITOM-90 is a specially designed scope that is attached to a high definition (HD) digital camera and displayed on a HD video monitor. This system was utilized in five patients undergoing infratentorial supracerebellar approaches for pineal region lesions. Surgical outcomes and pathologies are described. The device was used by three surgeons during five procedures. Three patients underwent surgery in the sitting position and two in the modified prone (Concorde) position. Pathologies included pineocytoma, lipoma, and germinoma. Total resection was achieved in three patients and subtotal in two patients. Surgeon assessment was positive; surgeons indicated that surgery with the VITOM-90 was more comfortable than with the operating microscope. Lack of stereopsis was considered a minor drawback. The VITOM-90 permitted a natural head and neck position. Operating room personnel and residents reported improved visualization of the anatomy. Using the VITOM-90 benefited surgeons during pineal region surgery by reducing strain and allowing the surgeon to operate from a comfortable position without increased operative time or complications. The improved comfort levels may translate into safer, more accurate surgeries in this complex area.

Abordaje endoscópico al atrio ventricular para toma de biopsia de tumor de la región pineal: a propósito de un caso

The usual endoscopic approach in the management of pineal region tumours consists of inserting the scope into the frontal horn of the lateral ventricle and advancing it through the foramen of Monro into the third ventricle. We report the case of a patient with a pineal tumour on whom we used an endoscopic approach through the ventricular atrium to obtain a biopsy by opening the choroidal fissure. This young 25-year-old man presented with headache and double vision. Papilloedema and Parinaud's syndrome were found on physical examination. Cranial magnetic resonance revealed a pineal mass and hydrocephalus. We initially performed a third ventriculostomy and a tumour biopsy through a frontal burr hole. The tissue sample was not useful for pathological diagnosis and we decided to perform a second endoscopic biopsy. The endoscopic approach to pineal region masses, reaching the ventricular atrium through a parietal burr hole and opening the choroidal fissure, makes it possible to take a biopsy using a single endoscopic approach without needing to cross other ventricular structures.