At times, germinomas will have a synchronous lesion in the hypothalamus, or even spread through the CSF pathway. The treatment of germinoma is controversial, except that surgery is usually not used as definitive treatment. Although a 'test' dose of radiation has been suggested in order to avoid a diagnostic biopsy, histologi-cal confirmation should be obtained whenever possible. This can be done via open craniotomy, stereotactic biopsy, or endoscopic biopsy through the third ventricle. Both radiation therapy and chemotherapy are effective in the treatment of germinoma. The standard radiation dose is 4800 cGy (or more) to the tumor area. Long-term survival is in excess of 80%.

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