Abstrato

The importance of neuroendoscopy for the treatment of tumors in pineal region.

Erik Simon

Although advances in neuroimaging and microsurgical technique have improved the safety and efficacy of pineal tumour surgery, the optimal treatment for pineal tumours and the frequently accompanying noncommunicating hydrocephalus is still debated. Individualizing therapy of the vast range of lesions that arise in the pineal area requires histopathologic diagnosis. Stereotactic biopsy and different "open" procedures are common methods for obtaining tissue diagnosis. Stereotactic biopsy has several drawbacks, including sampling inaccuracy, which can be especially troublesome in the pineal area due to the heterogeneity of many tumours found there, and the danger of bleeding due to the closeness to the brain's primary deep venous drainage system. Direct surgical excision is usually recommended, but it requires the patient to undergo a major surgery with all of its dangers when less invasive alternatives, such as radiation therapy for germinoma, may be available. If hydrocephalus is present, it should be treated before a formal tumour excision