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@article{818570,
author = {Hernesniemi, Juha and Romani, R. and Albayrak, BS. and Lehto, H. and Dashti, R. and Ramsey, C. 3rd and Karatas, A. and Cardia, A. and Navrátil, Ondřej and Piippo, A. and Fujiki, M. and Toninelli, S. and Niemelä, M.},
article_number = {6},
doi = {http://dx.doi.org/10.1016/j.surneu.2008.07.019},
keywords = {Infratentorial supracerebellar approach; Occipital interhemispheric approach; Pineal region lesions; Hydrocephalus; Follow-up},
language = {eng},
issn = {0090-3019},
journal = {Surgical Neurology},
title = {Microsurgical management of pineal region lesions: personal experience with 119 patients},
volume = {70},
year = {2008}
}
TY - JOUR
ID - 818570
AU - Hernesniemi, Juha - Romani, R. - Albayrak, BS. - Lehto, H. - Dashti, R. - Ramsey, C. 3rd - Karatas, A. - Cardia, A. - Navrátil, Ondřej - Piippo, A. - Fujiki, M. - Toninelli, S. - Niemelä, M.
PY - 2008
TI - Microsurgical management of pineal region lesions: personal experience with 119 patients
JF - Surgical Neurology
VL - 70
IS - 6
SP - 576-583
EP - 576-583
SN - 00903019
KW - Infratentorial supracerebellar approach
KW - Occipital interhemispheric approach
KW - Pineal region lesions
KW - Hydrocephalus
KW - Follow-up
N2 - Lesions of the pineal region are histopathologically heterogeneous but often accompanied with severe progression of clinical signs. Surgical treatment remains challenging because of the close vicinity of the deep venous system and the mesencephalo-diencephalic structures in this region. We present the surgical approaches and techniques in a consecutive series of 119 patients treated by the senior author (J.H.) between 1980 and 2007 at 2 different neurosurgical university centers in Kuopio and Helsinki, Finland. Methods: Of the included patients, 107 (90%) presented with pineal region tumors and 12 (10%) with vascular malformations. The ITSC route was used for removal of the lesion in 111 (93%) patients and the OIH approach in 8 (7%) patients. All except one patient were operated on in a sitting position. Results: We reviewed all clinical data and radiographic images and analyzed all surgical videos. The pineal lesions were removed completely in most cases (88%). There was no Surgical mortality. Twenty-two (18%) of the patients had complications in the postoperative period; these included 1 epidural hematoma, 9 transient Parinaud syndrome, 2 meningitis, 3 wound infections, 2 transient memory disturbances, 2 mild hemiparesis, 1 CSF fistula, and 2 cranial nerves palsies (Wand VI). During a 3.5-year follow-up, 12 patients with malignant lesions died; all patients with benign tumors survived. Conclusions: The ITSC route is a safe and effective surgical approach, associated with low morbidity, complete lesion removal, and definitive histopathologic diagnosis. Considering risk vs benefit, we therefore believe that the surgical treatment can be offered in most cases as the first treatment option for pineal tumors.
ER -
HERNESNIEMI, Juha, R. ROMANI, BS. ALBAYRAK, H. LEHTO, R. DASHTI, C. 3rd RAMSEY, A. KARATAS, A. CARDIA, Ondřej NAVRÁTIL, A. PIIPPO, M. FUJIKI, S. TONINELLI a M. NIEMELÄ. Microsurgical management of pineal region lesions: personal experience with 119 patients. \textit{Surgical Neurology}. roč.~70, č.~6, s.~576-583. ISSN~0090-3019. doi:10.1016/j.surneu.2008.07.019. 2008.
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