Neuroendoscopic anatomy and surgery in pineal region tumors - Role of neuroendoscopic procedure in the 'minimally-invasive preferential' management

The therapeutic modalities for pineal region tumors in Western countries di ffer from those in far-eastern countries, that is, Japan and Korea, mainly because of the different patient populations. The majority of pineal region tumors in Japan and Korea are radio sensitive and/or chemosensitive, and a djuvant therapy rather than extensive surgery plays the main part in the tr eatment of these tumors. The authors have applied minimally-invasive prefer ential management in pineal region tumors in last 8 years. For the therapeu tic regimen, if the tumor markers alpha-fetoprotein (AFP) and human chorion ic gonadotropin (HCG) were not detected in serum and there was significant ventricular dilation visualized on neuroimages, neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morpholo gical analysis of the tumor and the intraventricular structures, followed b y third-ventriculostomy. In the results, our minimally-invasive preferentia l regimen clarified the precise indication for neuroendoscopic procedures, and the majority of our patients with dilated ventricles and no evidence of tumor markers were treated satisfactorily with effective neuroendoscopic p rocedures as the initial procedure. Then avoided unnecessary craniotomy and radiotherapy and promised excellent therapeutic outcomes. Neuroendoscopic procedures have a great advantage in the management of chemo- or radiosensi tive tumors, such as germinoma, pineoblastoma, or primitive neuroectodermal tumor. The neuroendoscopic anatomy including the lateral and third ventric les with a pineal region tumor with or without tumor dissemination was desc ribed in detail, together with the neuroendoscopic surgical technique.