Direct surgery for recurrent tumors and residual tumors in pineal region after radiotherapy

In trearment of pineal tumors, radiotherapy with a shunting operation has been generally adopted because germinomas were the most common of pineal tumors, and also because radical resection of these tumors has resulted in high mortality and morbidity. However, about 10% of the tumors in the pineal region are mixed germ cell tumors, and a combination of shunting operation and irradiation is limited in its effect on this kind of lesion. The authors have recently operated with good results on these recurrent tumors and the residual tumor by infratentorial supracerebellar approach in the concorde position. So, these cases were presented and the treatment for pineal tumor was discussed. Case 1 : A 15-year-old boy was admitted with increased intracranial pressure (IICP) on May, 1979. Computerized tomography (CT) scans at that time showed pineal and suprasellar tumors with ventricular dissemination. A ventriculoperitoneal shunt followed by radiation therapy was peerformed. The tumors seemed to have almost disappeared after this therapy and the patient continued well until he complained of severe headache and general fatigue in September, 1984. CT scans showed a reccurrent tumor with cystic component. He was operated for the subtotal removal of the tumor on November 26, 1984 and was discharged with slight mental dullness two months postperatively. Histological diagnosis of the specimen was mature teratoma. Case 2 : A 10-year-old boy was admitted with IICP and in a drowsy state on October 1, 1984. CT scans showed a pineal tumor with hydrocephalus. A combination of radiation and a shunting operation was performed. CT scans after this therapy showed a residual tumor but with tumor shrinkage. He was operated for the radical removal of the tumor. The Postoperative course was uneventful and he was discharged with Prinaud's sign on month after operation. Histological diagnosis of the specimen was teratoid. Case 3 : A 13-year-old boy was admitted with IICP and diolopia on March 14, 1986. CT scans showed a pineal tumor with hydrocephalus. A combination of radiation and shunting operation was performed was performed. CT scans after this therapy showed a small residual tumor with calcification. He was operared for the total removal of the tumor by Laser. Histological diagnosis of the tumor was connective tissue.