Pineal region tumor (PRT) [Neurosurgery Wiki]

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====== Pineal region tumor (PRT) ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1BWfEy0KKty9kmO2TyhECdxFJbookWxVTYkb35j8lGyOsln5hZ/?limit=15&utm_campaign=pubmed-2&fc=20230213115732}}
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===== Key concepts =====

● wide variety of [[pathology]]: [[germ cell tumor]]s (mostly [[germinoma]]s, [[teratoma]]s), astrocytomas, & pineal tumors (mostly pineoblastomas) account for most tumors

● pineal region tumors are more common in children than in adults

● in children, most tumors are germinomas or astrocytomas;
in adults, meningiomas and gliomas predominate

● see [[germ cell tumor]]s 

● see [[pineal cyst]]s 

===== Epidemiology =====

[[Pineal region tumor epidemiology]].



===== Pineal region tumor classification =====

[[Pineal region tumor classification]].

===== Clinical features=====

[[Pineal region tumor clinical features]].


===== Diagnosis =====

see [[Pineal region tumor diagnosis]].

===== Differential diagnosis =====

see [[Pineal region tumor differential diagnosis]].

===== Complications =====

[[Obstructive hydrocephalus from pineal region tumor]]

===== Treatment =====

see [[Pineal region tumor treatment]].

===== Case series =====
see [[Pineal region tumor case series]].

===== Case reports =====
a 72-year-old male patient with pineal region tumor and obstructive hydrocephalus for which an endoscopic third ventriculostomy was done with biopsy of the tumor showing primary colorectal origin in a patient known to be previously healthy.

Conclusion: Intracranial metastasis to the pineal region is considered rare especially in cases without widely spread systematic cancer or without presence of other metastatic lesions in the brain. The case we presented suggests that we should consider pineal region metastasis as part of our differential whenever we encounter patients with an isolated pineal lesion. Endoscopic third ventriculostomy can be a better treatment option to treat obstructive hydrocephalus caused by the lesion potentially avoiding peritoneal dissemination
((Kawtharani S, Moussalem C, El Houshiemy M, Horanieh E, Najjar M. A rare case of metastatic colon cancer to the pineal region: A case report. Surg Neurol Int. 2022 Sep 30;13:453. doi: 10.25259/SNI_698_2022. PMID: 36324963; PMCID: PMC9610188.)).

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Cho et al. presented a case of a 75-year-old woman with known pineal region [[mass]] for 18 years, who presented with progressive classic signs and symptoms of [[obstructive hydrocephalus]] over the past six months. The preoperative imaging confirmed a contrast-enhancing [[pineal region tumor]], which appeared to be obstructing the [[aqueduct of Sylvius]], causing proximal obstructive hydrocephalus. 5mg/kg of [[ICG]] was delivered intravenously 24 hours before the surgery. The patient underwent an [[endoscopic third ventriculostomy]] and a [[biopsy]] of the [[pineal]] lesion. The [[tumor]] demonstrated clear near-infrared fluorescence which was distinct from surrounding [[third ventricle floor]] and [[ependyma]]. The signal to background ratio was 2.9. The final pathology report revealed a WHO Grade I [[pineocytoma]].

They reported on a novel application of near-infrared [[fluorescence]] for tumor identification of [[pineal region tumor]]s, using the Second Window ICG technique
((Cho A, Cho SS, Buch VP, Buch LY, Lee JYK. Second Window ICG Near Infrared
Fluorescent TransVentricular Biopsy of a Pineal Tumor: A Case Report with a
2-Dimensional Operative Video. World Neurosurg. 2019 Oct 26. pii:
S1878-8750(19)32741-X. doi: 10.1016/j.wneu.2019.10.113. [Epub ahead of print]
PubMed PMID: 31669685.
)).