STEREOTAXIC MANAGEMENT OF LESIONS OF THE PINEAL REGION

OBJECTIVE: The relevance of the computed tomography-guided stereotacti c approach for the management of lesions of the pineal region is analy zed. METHODS: In a retrospective analysis conducted between 1985 and 1 993, the risk profile, the diagnostic accuracy, and the therapeutic re levance of the stereotactic approach In 106 patients was studied. Surv ival analysis was used to assess-the reliability of the stereotactical ly obtained diagnosis in terms of follow-up observation. RESULTS: A hi stological diagnosis was obtained in 103 of the 106 patients. In three patients, a conclusive diagnosis could not be established because of intraoperative complications. One lesion was misdiagnosed as a pineocy toma instead of a pineoblastoma. Two of the 106 patients died; 9 patie nts experienced perioperative morbidity. In 38 patients, the stereotac tic approach was also useful for therapy. Cyst aspiration and/or inter nal drainage was performed in 18 patients with symptomatic cystic lesi ons, and radiosurgical treatment with use of interstitial (125)iodine was performed in 16 patients with low-grade tumors and in 4 patients w ith solitary metastases. In 12 patients, the obtained tissue diagnosis was the basis for deferring additional therapy. In 43 patients with g erm-cell tumors, pineoblastomas, or malignant gliomas, a stereotactic biopsy was the starting point for additional radiotherapy/chemotherapy . Open tumor resection played a minor role (five patients). CONCLUSION : The stereotactic approach to the pineal region is a relatively safe procedure in experienced hands. The diagnosis obtained by computed tom ography-guided stereotactic biopsy is a valid basis for treatment deci sions. Long-term follow-up observation of the benign lesions is necess ary for a definite confirmation of diagnostic accuracy.