Efficacy of neuroendoscopic procedures in minimally invasive preferential management of pineal region tumors: a prospective study

Object. This prospective study is based on a consecutive series of 20 patie nts with pineal region tumors who underwent minimally invasive preferential management. The purpose of this report is to discuss the role of neuroendo scopic procedures in the management of pineal region tumors. Methods. If the tumor markers alpha-fetoprotein and human chorionic gonadot ropin were not detected in serum and there was significant ventricular dila tion visualized on neuroimages, neuroendoscopic surgery was first applied f or turner debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventric ulostomy. Subsequent procedures were determined on the basis of verified individual t umors. For treatment of germinomas and pineoblastomas, if no tumor dissemin ation was confirmed by pre-, intra-, or postoperative findings, stereotacti c radiotherapy or radiosurgery was performed after one course of chemothera py with the ICE regimen (isofomid, cisplatin, and etoposide) and followed b y two additional courses of chemotherapy. For treatment of malignant germ c ell tumors, after extensive surgery, adjuvant chemotherapy with the ICE reg imen was performed in three courses in all cases. Then radiotherapy was sta rted using various methods, depending on the evidence of tumor disseminatio n. For treatment of teratomatous and neuroectodermal rumors other than pine oblastomas, extensive surgical removal was performed. As fur adjuvant thera py, if the turner was a low-grade glioma or if the patient was younger than 5 years of age, postoperative treatment did not include radiotherapy. If t he tumor was a malignant teratoma or high-grade glioma, conventional focal radiotherapy was Fel-formed, followed by chemotherapy with ICE for I year. All but two treated patients had ventriculomegaly. Neuroendoscopic procedur es were performed in six of 15 treat ed patients. Neuroendoscopic biopsy wi th tumor debulking offend enough material for tissue diagnosis, including i mmunohistochemical analysis and, in one case, revealed evidence of tumor di ssemination undetectable on neuroimaging. With one exception, no shunt was required in any patient undergoing endoscopic third ventriculostomy. Stereo tactic radiotherapy was per-formed in indicated cases. Favorable therapeuti c outcomes were obtained in all cases of ger minoma and pineoblastoma, with follow-up periods ranging from 24 months to 6.5 years. Conclusions. Our minimally invasive preferential regimen clarified the prec ise indication for neuroendoscopic procedures, and the majority of our pati ents with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic procedures as the initial pro cedure, avoiding unnecessary craniotomy and radiotherapy and promising exce llent therapeutic outcomes. The treatment for malignant pineal region tumor s remains a subject fur further study.