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Surgical
Strategies for Treating Patients with Pineal Region Tumors
Jeffrey N. Bruce, Alfred T. Ogden
Department
of Neurological Surgery, Columbia University, 710 W. 168th Street, Room 434, New
York, NY 10032; Tel.: 212-305-7346; Fax: 212-305-2026; E-mail: jnb2@columbia.edu
[J.N.B.]. Department of Neurological Surgery, The Neurological
Institute, Columbia University, New York, NY, USA [A.T.O.].
Optimal
management of pineal region tumors depends on securing an accurate histologic
diagnosis to facilitate management customized to the nuances of specific
pathologies.
As an initial step, surgical intervention by either stereotactic biopsy or open
surgery is necessary to obtain tissue for pathologic examination.
Stereotactic biopsy has the benefit of relative ease and minimal morbidity but
is associated with greater likelihood of diagnostic inaccuracy compared to open
surgery where more extensive tissue sampling is possible.
The role
of surgical debulking in the management of pineal tumors is clearly defined for
some tumors but is less evident for others.
Among the one third of pineal tumors that are benign or low grade, complete
surgical resection is achievable and constitutes optimal management with
excellent long-term recurrence-free survival.
The benefits of aggressive surgical resection among malignant tumors are less
clear but several studies have correlated degree of tumor removal with improved
outcome.
Advances
in technology, surgical technique, and post-operative care have minimized
surgical complications, however all surgical procedures in the pineal region,
including both stereotactic biopsy and open surgery, are potentially
hazardous.
Advanced judgment, experience, and expertise are necessary to achieve rates of
success sufficient to justify aggressive management.
Management strategies using stereotactic biopsy, endoscopy, and radiosurgery can
also provide favorable outcomes in some cases.
Selective incorporation of these innovations can be expected to improve the
already highly favorable outcome for all pineal region tumors.
Keywords: germinoma,
germ cell tumor, outcome, pineal parenchymal tumor, pineal tumor, radiosurgery,
stereotactic biopsy, surgery
Copyright
©
2004 Kluwer Academic Publishers.
All rights reserved
Source:
http://ipsapp007.kluweronline.com/IPS/content/ext/x/J/5042/I/124/A/18/abstract.htm
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