surgical approach to pineal region tumor

1. SURGICAL APPROACHES TO
PINEAL REGION TUMORS

2. Introduction
• Extra-axial structure: readily resectable from plane
• Midline, quadrigeminal cistern
• Pineal mass originate infratentorially and expand into the 3rd
ventricle, thalamus or quadrigeminal plate or midbrain.

3. Boundaries of pineal region
• Gland is located in dienchephalic roof at the posterior extremity to 3rd ventricle
between the habenular commissure and the posterior commissure, lies between the
superior colliculi and basal to the splenium of the corpus callosum.
• Anteriorly: Posterior commisure and posterior part of 3rd ventricle.
• Posteriorly: Habenular commisure and cerebellar vermis
• Superiorly: Splenium
• Inferiorly: Quadrigeminal plate and tectum

5. VENOUS DRAINAGE
• The great vein of Galen and its tributaries form a roof-like, dense venous network
above the pineal body and the quadrigeminal plate.

13. Tumor markers
• Presence indicates malignant germ cell tumor, converse not true
• More significance in follow up/ recurrence
• Help avoid unnecessary surgery

16. SURGICAL ANATOMY
• Most tumors arise from or attached to undersurface of velum
interpositum
• Tumors rarely extend above velum
• Blood supply comes from within velum mainly from M P.ch & L P.ch with
anastomoses to pericallosal & quadrigeminal artery
• Most tumors are centered at pineal gland, some extend to Foramen of
Monroe
• Mostly, ICV, Galen , Rosenthal & precentral cerebellar veins surround or cap
the periphery of these tumors.
• Rarely, ICV are ventral to tumor.
• Highly vascular tumors
– Pineoblastomas
– Hemangioblastomas

33. Complications of supratentorial approach

38. Thank You