Pineal region tumours

INVESTIGATIONS CT scan shows a mass projecting into the posterior aspect of the third ventricle with associated dilatation of the third and lateral ventricles.

T, weighted MRI with gadolinium

Sagittal MRI clarifies the exact tumour relationship to the third ventricle.

Pineal region tumour (pinealcytoma)

Pineocytomas - may appear calcified. Teratomas - may contain mixed densities from fat to calcification.

Tumour markers - Serum/CSF human chorionic gonadotrophs 1 May rise in patients

- Serum/CSF alpha fetoprotein j with germinoma

CSF cytology: Malignant pineal region tumours can metastasise through CSF and cytology is important in planning treatment.

MANAGEMENT

Hydrocephalus often requires urgent treatment with a ventriculoperitoneal shunt. Large tumours may obstruct the foramen of Munro, making bilateral ventricular drainage necessary.

The site of pineal region tumours makes the operative approach difficult, although modern techniques have considerably diminished the risks involved. Either stereotactic biopsy or more recently, biopsy via an endoscope guided into the third ventricle can obtain a tissue diagnosis, although both procedures carry some risk and some neurosurgeons advocate direct operative exploration as the procedure of first choice. Others still advise an initial trial of radiotherapy without first obtaining a tissue diagnosis, particularly in the presence of elevated CSF or serum tumour markers. About 70% of tumours (particularly the germinomas) are radiosensitive and show a dramatic reduction in size. Failure to respond indicates the need for either biopsy or direct operation. The entire craniospinal axis is irradiated if CSF cytology is positive.

Patients undergoing a CSF shunt followed by radiotherapy survive 4 years on average.

Routes of dircct approach

1 - Infratcntorial

2 - Supratcntorial

3 - Transvcntricular

Routes of dircct approach

1 - Infratcntorial

2 - Supratcntorial

3 - Transvcntricular

Was this article helpful?

0 0
Peripheral Neuropathy Natural Treatment Options

Peripheral Neuropathy Natural Treatment Options

This guide will help millions of people understand this condition so that they can take control of their lives and make informed decisions. The ebook covers information on a vast number of different types of neuropathy. In addition, it will be a useful resource for their families, caregivers, and health care providers.

Get My Free Ebook


Post a comment