Treatment and Approaches for the Pineal Gland Region

  • Baha’eddin A. MuhsenEmail author
  • Hamid Borghei-Razavi
  • Samer S. Hoz


The key for successful treatment starts with correct diagnosis. These lesions have no pathognomonic features on neuroimaging. The surgery for pineal region tumors is necessary to obtain a tissue diagnosis as many diverse tumors could arise in this region, benign or malignant and sometimes vascular lesions. The surgical approaches for pineal lesion have evolved, becoming safer and more efficient with the use of microneurosurgery and neuroendoscopy which helped to decrease the mortality and morbidity of surgery. The choice of surgical approach must be based on surgeon’s preference as well as the patient’s anatomy. The two most commonly utilized surgical approaches are infratentorial-supracerebellar (ITSC) and occipital transtentorial (OTT) approach.


Pineal Management Surgical Supracerebellar Transtentorial 


  1. 1.
    Choudhry O, Gupta G, Prestigiacomo CJ. On the surgery of the seat of the soul: the pineal gland and the history of its surgical approaches. Neurosurg Clin. 2011;22(3):321–33.CrossRefGoogle Scholar
  2. 2.
    Oppenheim H, Krause F. Operative ErfolgebeiGeschwiilsten der Schhugel—und Vierhugelgegend. Bed Klin Wschr. 1913;50:2316–22.Google Scholar
  3. 3.
    Dandy WE. An operation for the removal of pineal tumors. Surg Gynecol Obstet. 1921;33:113–9.Google Scholar
  4. 4.
    Pendl G. The surgery of pineal lesions—historical perspective. Diagnosis and treatment of pineal region tumors. Baltimore: Williams & Wilkins; 1984. p. 139–54.Google Scholar
  5. 5.
    Camins MB, Schlesinger EB. Treatment of tumors of the posterior part of the third ventricle and the pineal region: a long term follow-up. Acta Neurochir. 1978;40(1–2):131–43.CrossRefGoogle Scholar
  6. 6.
    Horrax G. Extirpation of a huge pinealoma from a patient with pubertas praecox: a new operative approach. Arch Neurol Psychiatr. 1937;37(2):385–97.CrossRefGoogle Scholar
  7. 7.
    Foerster O. Ein fall von vierhfigeltumordurch operation entfernt. Nervenkr Arch Psychiat. 1928;84:515–6.Google Scholar
  8. 8.
    Isamat F. Tumors of the posterior part of the third ventricle: neurosurgical criteria, vol. 6. New York: Springer; 1979.Google Scholar
  9. 9.
    Rozario R, Adelman L, Prager RJ, Stein BM. Meningiomas of the pineal region and third ventricle. Neurosurgery. 1979;5(4):489–95.CrossRefGoogle Scholar
  10. 10.
    Stein BM. The supracerebellar infratentorial approach to pineal lesions. J Neurosurg. 1971;35(2):197–202.CrossRefGoogle Scholar
  11. 11.
    Fukushima T, Ishijima B, Hirakawa K, Nakamura N, Sano K. Ventriculofiberscope: a new technique for endoscopic diagnosis and operation. J Neurosurg. 1973;38(2):251–6.CrossRefGoogle Scholar
  12. 12.
    Van Wagenen WP. A surgical approach for the removal of certain pineal tumors. Report of a case. Surg Gynecol Obstet. 1931;53:216–20.Google Scholar
  13. 13.
    Robinson S, Cohen AR. The role of neuroendoscopy in the treatment of pineal region tumors. Surg Neurol. 1997;48(4):360–7.CrossRefGoogle Scholar
  14. 14.
    Regis J, Bouillot P, Rouby-Volot F, Figarella-Branger D, Dufour H, Peragut JC. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery. 1996;39(5):907–14.PubMedGoogle Scholar
  15. 15.
    Mottolese C, Szathamari A, Beuriat PA, Grassiot B, Simon E. Neuroendoscopy and pineal tumors: a review of the literature and our considerations regarding its utility. Neurochirurgie. 2015;61(2–3):155–9.CrossRefGoogle Scholar
  16. 16.
    Soweidane M, Luther N. Endoscopic resection of solid intraventricular tumors. J Neurosurg. 2006;105:271–8.CrossRefGoogle Scholar
  17. 17.
    Chibbaro S, Di Rocco F, Makiese O, Reiss A, Poczos P, Mirone G, Servadei F, George B, Crafa P, Polivka M, Romano A. Neuroendoscopic management of posterior third ventricle and pineal region tumors: technique, limitation, and possible complication avoidance. Neurosurg Rev. 2012;35(3):331–40.CrossRefGoogle Scholar
  18. 18.
    Shirane R, Shamoto H, Umezawa K, Su CC, Kumabe T, Jokura H, Yoshimoto T. Surgical treatment of pineal region tumors through the occipital transtentorial approach: evaluation of the effectiveness of intra-operative micro-endoscopy combined with neuronavigation. Acta Neurochir. 1999;141(8):801–8.CrossRefGoogle Scholar
  19. 19.
    Yamamoto M, Oka K, Takasugi S, Hachisuka S, Miyake E, Tomonaga M. Flexible neuroendoscopy for percutaneous treatment of intraventricular lesions in the absence of hydrocephalus. Minim Invasive Neurosurg. 1997;40(04):139–43.CrossRefGoogle Scholar
  20. 20.
    Poppen JL. The right occipital approach to a pinealoma. J Neurosurg. 1966;25(6):706–10.CrossRefGoogle Scholar
  21. 21.
    Moreau JJ, Ravon R, Caix M, Salamon G, Brassier G, Velut S. Anatomical basis of the microsurgical approach to the pineal gland. Anat Clin. 1985;7(1):3–13.CrossRefGoogle Scholar
  22. 22.
    Choque-Velasquez J, Colasanti R, Resendiz-Nieves JC, Jahromi BR, Kozyrev DA, Thiarawat P, Hernesniemi J. Supracerebellar infratentorial paramedian approach in Helsinki neurosurgery: cornerstones of a safe and effective route to the pineal region. World Neurosurg. 2017;105:534–42.CrossRefGoogle Scholar
  23. 23.
    Yasargil MG. Paramediansupracerebellar approach. In: Microneurosurgery, vol. I. New York: Georg Thieme Verlag; 1984. p. 242.Google Scholar
  24. 24.
    Van den Bergh R. Lateral-paramedian infratentorial approach in lateral decubitus for pineal tumors. Clin Neurol Neurosurg. 1990;92(4):311–6.CrossRefGoogle Scholar
  25. 25.
    Kulwin CG, Matsushima K, Malekpour M, Cohen-Gadol AA. Lateral supracerebellar infratentorial approach for microsurgical resection of large midline pineal region tumors: techniques to expand the operative corridor. J Neurosurg. 2016;214(1):269–76.CrossRefGoogle Scholar
  26. 26.
    Little KM, Friedman AH, Fukushima T. Surgical approaches to pineal region tumors. J Neuro-Oncol. 2001;54(3):287–99.CrossRefGoogle Scholar
  27. 27.
    Clark WK, Batjer HH. The occipital transtentorial approach. In: Apuzzo MLJ, editor. Surgery of the third ventricle. Baltimore, MD: Williams and Wilkins; 1998. p. 721–42.Google Scholar
  28. 28.
    McComb JG, Levy ML, Apuzzo ML. The posterior intrahemispheric retrocallosal and transcallosal approaches to the third ventricle region. In: Apuzzo MLJ, editor. Surgery of the third ventricle. Baltimore, MD: Williams & Wilkins; 1998. p. 743.Google Scholar
  29. 29.
    Gore PA, Gonzalez LF, Rekate HL, Nakaji P. Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report. Operative Neurosurg. 2008;62(suppl_1):ONSE108–9.CrossRefGoogle Scholar
  30. 30.
    Sood S, Hoeprich M, Ham SD. Pure endoscopic removal of pineal region tumors. Childs Nerv Syst. 2011;27(9):1489–92.CrossRefGoogle Scholar
  31. 31.
    Zanini MA, Rondinelli G, Fernandes AY. Endoscopic supracerebellar infratentorial parapineal approach for third ventricular colloid cyst in a patient with quadrigeminal cistern arachnoid cyst: case report. Clin Neurol Neurosurg. 2013;115(6):751–5.CrossRefGoogle Scholar
  32. 32.
    Chaussemy D, Cebulla H, Coca A, Chibarro S, Proust F, Kehrli P. Interest and limits of endoscopic approaches for pineal region tumors. Neurochirurgie. 2015;61(2–3):160–3.CrossRefGoogle Scholar
  33. 33.
    Ruge JR, Johnson RF, Bauer J. Burr hole neuroendoscopic fenestration of quadrigeminal cistern arachnoid cyst: technical case report. Neurosurgery. 1996;38(4):830–7.CrossRefGoogle Scholar
  34. 34.
    Zaidi HA, Elhadi AM, Lei T, Preul MC, Little AS, Nakaji P. Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches. World Neurosurg. 2015;84(2):257–66.CrossRefGoogle Scholar
  35. 35.
    Shahinian H, Ra Y. Fully endoscopic resection of pineal region tumors. J Neurolog Surg Part B. 2013;74(03):114–7.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Baha’eddin A. Muhsen
    • 1
    Email author
  • Hamid Borghei-Razavi
    • 1
  • Samer S. Hoz
    • 2
  1. 1.Department of Neurosurgery, Rose Ella Burkhardt Brain Tumor & Neuro-Oncology CenterNeurological Institute, Cleveland ClinicClevelandUSA
  2. 2.Neurosurgery Teaching HospitalBaghdadIraq

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