Pineal region surgery. Experience in 22 patients

Background and purpose. - Different approaches to the pineal region are described in the literature with high mortality and morbidity. We report our experience with two different approaches (occipitoparietal or infratentorial supracerebellar approaches) for pineal region. Methods. - Between 1986 and 1997, 25 operations were performed in 22 patients. Preoperative work-up included a CT-scan with conventional angiography (for older patients), magnetic resonance imaging with angio-graphic study (angio-MRI) for the others. Two different approaches, the occipitoparietal (n = 14) or the infratentorial supracerebellar (n = 8) ones, were used. Three patients had a stereotactic biopsy, followed by a total resection for one of them. Results. - The mortality and morbidity induced by the approaches were low compared to the series of the literature. Only 2 patients were worsened by the surgery: Patient 4 developed hemianopsia after an occipitoparietal approach and patient 21 temporary Parinaud syndrome after resection of a teratoma by supracerebellar infratentorial approach. One patient improved his neurological status but died on the 10,h postoperative day, from pulmonary embolism. Conclusions. - Total or partial resection of well-defined pineal region lesions by direct neurosurgical approaches can be achieved in most cases with low morbidity. The choice among the two surgical occipitoparietal or infratentorial supracerebellar approaches depends on the size and the location of the lesion in the pineal area, its relation to the ventricular system, the median line and the splenium. Angiographic sequences in magnetic resonance with study of the deep veins are helpful in this respect.