Pineal gland presentations

1. M S N I S H A M A T H E W
Pineal Gland tumor

2. Pineal gland
The pineal gland (also called the pineal body,
epiphysis cerebri, epiphysis, conarium or
the "third eye") is a small endocrine gland in the
vertebrate brain. It produces the serotonin
derivative melatonin,Its shape resembles a tiny
pine cone (hence its name), and it is located near
the centre of the brain, between the two
hemispheres, tucked in a groove where the two
rounded thalamic bodies join.

4. Pineal gland Tumor
 Pineal region tumors are derived from cells located
in and around the pineal gland (pinocyte & pineal
parenchymal cells)
 This cell is a specialized neuron related to retinal
rods and cones.

5. Epidemiology
 These tumors represent about 1% of all brain
tumors but account for 3% to 8% of the
intracranial tumors that occur in children.
 Most children are aged 10-20 years at
presentation, with the average age at presentation
being 13 years.
 Adults typically are older than 30 years at
presentation.

6. Etiology
 Tumors can be divided into germ cell and non–
germ cell derivatives.
 Most tumors are a result of displaced embryonic
tissue, malignant transformation of pineal
parenchymal cells, or transformation of
surrounding astroglia.
 No specific genetic mutations have been
associated with sporadic pineal region tumors

7. Pathophysiology
Transformation into pineal tumor
local infiltration of neural structures Vision changes
Suppressing Aqeu duct
Increased ICP
Hydrocephalus

8. Clinical Manifestations
 Headache
 Nausea
 Vomiting caused by aqueductal compression
 Obstructive hydrocephalus.
 Increased ICP, Seizures, Vision changes (Inability to focus on objects,
double vision, and impairment of eye movements)
 Lethargy
 Obtundation
 In Children endocrine malfunction
 Hydrocephalus or concurrent suprasellar- diabetes insipidus
 Pseudo precocious puberty
 In a large series of patients , 93% of girls older than 12 years
had secondary amenorrhea
 33% of patients younger than 15 years had growth arrest.

9. Diagnostic findings
 Physical examination & Clinical history
 Neurological exam: vision, hearing, balance,
coordination and reflexes
 CT Scan
 MRI Scan
 Angiogram
 X-rays of the Head and Skull
 Magnetic resonance spectroscopy (MRS)
 Single-photon emission computerized tomography
(SPECT)
 Positron emission tomography (PET) scanning
 Biopsy

10. Treatment
Surgery:
The surgeon drills a small hole called burr hole, into
the skull. A narrow, thin needle is then inserted
through the hole. Tissue is removed using the needle,
which is frequently guided by CT scanning
if possible minimally invasive technique is used

12.  For Hydrocephalus : Endoscopic third
ventriculostomy or a ventricular shunt is placed

13.  Radiation Therapy-
More than 70 percent of tumors are highly sensitive to
radiation therapy.
Stereotactic radiosurgey
Gamma Knife

15. Chemotherapy
 Cisplatin, vinblastine and bleomycin
 Cisplatin and bleomycin
 Vincristine, actinomycin D, and cyclophosphamide