The management of pineal area tumors: A recent reappraisal

Authors

  • Paul H. Chapman MD,

    Corresponding author
    1. Division of Neurosurgery and the Department of Radiation Medicine, Massachusetts General Hospital, Boston, Massachusetts
    • Department of Neurosurgery, Massachusetts General Hospital, Boston, Maryland 02114
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    • Assistant Professor of Surgery, Harvard Medical School; Assistant Visiting Neurosurgeon, Massachusetts General Hospital.

  • Rita M. Linggood MD

    1. Division of Neurosurgery and the Department of Radiation Medicine, Massachusetts General Hospital, Boston, Massachusetts
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    • Instructor in Radiation Medicine, Harvard Medical School; Assistant Radiation Therapist, Massachusetts General Hospital.


Abstract

This study concerns our experience with 22 pineal area tumors from 1972 through 1977. Eleven identified tumors included: three gliomas, three pineoblastomas, two endodermal sinus tumors, one germinoma, one epidermoid, and one metastasis. Three others were presumptively germinomas. Twelve cases were treated by means of radiation and shunting if necessary. Eight patients underwent direct surgery and then radiotherapy if appropriate. There were 6 deaths from recurrence. Three patients had pineoblastomas and 2, endodermal sinus tumors. Death occurred in spite of radiologic evidence of radiation response. Cerebrospinal fluid (CSF) cytology was positive in 2 of 7 cases involving potentially disseminating tumors and negative in 2 cases involving spinal metastases. We conclude that radiation response and CSF cytology are insufficient to determine optimum treatment. Direct operations, which were not associated with mortality or serious morbidity were most useful for providing a tissue diagnosis.

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