Neurosurgical Management of Pineal Tumours

A variety of tumours arise in the pineal region [44]. Germ cell tumours (GCTs), which is a heterogeneous group of various neoplasms, is the most common type, followed by pineal parenchymal cell tumours, pine-ocytomas and pineoblastomas. Planning of surgical management depends on the biological nature of individual neoplasms and is determined by preoperative radiological findings and an intraoperative histological diagnosis using frozen sections, as well as the surgeon’s experience. Germinoma, which is the most common tumour originating from the pineal body, can be cured by low-dose radiotherapy and chemotherapy, and nowadays needs only to be biopsied. On the other hand, mature teratomas, dermoid or epidermoid cysts, neurocytomas, and meningiomas can be cured by radical surgical resection. Pineal parenchymal tumours and ependymomas require surgical removal and adjuvant radiotherapy. Other tumours, such as malignant teratomas or embryonal carcinomas, need a sophisticated combination therapy including surgery, radiation therapy, and chemotherapy. For such tumours, neurosurgeons should recognize that a surgical resection is only a part of the combination therapy. For instance, application of an appropriate neoadjuvant therapy prior to a radical surgical removal will remarkably reduce the surgical risk for the patients with large malignant pineal tumours.