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Refining
the staging evaluation of pineal region germinoma using neuroendoscopy and the
presence of preoperative diabetes insipidus
Alyssa
T. Reddy, John C. Wellons III, Jeffrey C. Allen, John B. Fiveash, Hussein
Abdullatif, Karen W. Braune, Paul A. Grabb
Departments of Pediatrics
(A.T.R., H.A., K.W.B.), Surgery, Section of Pediatric Neurosurgery (J.C.W.,
P.A.G.), and Radiation Oncology (J.B.F.), University of Alabama at Birmingham,
Birmingham, AL 35233; and Departments of Neurology and Pediatrics, Beth Israel
Medical Center (J.C.A.), New York, NY 10128; USA
Treatment
strategies for CNS germinoma are currently evolving.
Current approaches include reducing the volume and dose of radiation by adding
pre-irradiation chemotherapy.
Very accurate staging is necessary with such an approach to prevent
failures.
Eight consecutive patients with pineal germinoma at one institution underwent
endoscopic surgery for tumor biopsy, direct visualization of the third
ventricular region, and third ventriculostomy for those with
hydrocephalus.
All patients were treated with 4 cycles of chemotherapy.
Conformal field radiation therapy followed, with the dose to the tumor bed
dependent on the response to chemotherapy.
Patients who had MRI, endoscopic, or cerebrospinal fluid evidence of
multicentric or disseminated disease also received craniospinal radiation.
Six patients had diabetes insipidus (DI) at presentation.
All 6 had tumor studding the floor of the third ventricle on endoscopic
visualization, while only 4 of those patients had MRI evidence of disease in
that region.
All patients have completed therapy and are alive, with no evidence of disease
at median follow-up of 31.5 months from diagnosis.
Direct endoscopic visualization of the third ventricular region may be more
sensitive than MRI for evaluating the presence of suprasellar disease and
appears to add important information.
This parameter should be added to the staging evaluation when feasible.
In this series, the presence of DI was 100% predictive of suprasellar disease,
even when the MRI was negative for involvement of that region.
Patients should be evaluated for DI as part of the initial staging, and if it is
present, the patients should be treated for suprasellar disease regardless of
MRI findings.
© 2003 Duke
University Press
Source: http://konstanza.ingentaselect.com/vl=586815/cl=92/nw=1/rpsv/cgi-bin/linker?ini=dup_no&reqidx=/cw/dup/15228517/v6n2/s6/p127
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