Stereotactic management of lesions of the pineal region

被引:77
作者
Kreth, FW
Schatz, CR
Pagenstecher, A
Faist, M
Volk, B
Ostertag, CB
机构
[1] UNIV FREIBURG,ABT STEREOTAKT NEUROCHIRURG,DEPT STEREOTACT NEUROSURG,D-79106 FREIBURG,GERMANY
[2] UNIV FREIBURG,DEPT NEUROPATHOL,D-79106 FREIBURG,GERMANY
[3] UNIV FREIBURG,DEPT NEUROL,D-79106 FREIBURG,GERMANY
关键词
(125)iodine; pineal tumors; pineoblastomas; pineocytomas; radiosurgery; radiotherapy; stereotactic biopsy;
D O I
10.1097/00006123-199608000-00010
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
OBJECTIVE: The relevance of the computed tomography-guided stereotactic approach for the management of lesions of the pineal region is analyzed. METHODS: In a retrospective analysis conducted between 1985 and 1993, the risk profile, the diagnostic accuracy, and the therapeutic relevance of the stereotactic approach In 106 patients was studied. Survival analysis was used to assess-the reliability of the stereotactically obtained diagnosis in terms of follow-up observation. RESULTS: A histological diagnosis was obtained in 103 of the 106 patients. In three patients, a conclusive diagnosis could not be established because of intraoperative complications. One lesion was misdiagnosed as a pineocytoma instead of a pineoblastoma. Two of the 106 patients died; 9 patients experienced perioperative morbidity. In 38 patients, the stereotactic approach was also useful for therapy. Cyst aspiration and/or internal drainage was performed in 18 patients with symptomatic cystic lesions, and radiosurgical treatment with use of interstitial (125)iodine was performed in 16 patients with low-grade tumors and in 4 patients with solitary metastases. In 12 patients, the obtained tissue diagnosis was the basis for deferring additional therapy. In 43 patients with germ-cell tumors, pineoblastomas, or malignant gliomas, a stereotactic biopsy was the starting point for additional radiotherapy/chemotherapy. Open tumor resection played a minor role (five patients). CONCLUSION: The stereotactic approach to the pineal region is a relatively safe procedure in experienced hands. The diagnosis obtained by computed tomography-guided stereotactic biopsy is a valid basis for treatment decisions. Long-term follow-up observation of the benign lesions is necessary for a definite confirmation of diagnostic accuracy.
引用
收藏
页码:280 / 289
页数:10
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