Microneurosurgical Operative Treatment Of The Tumor From Pineal Region

The pineal body area tumor accounts for 0.4-1% in the encephalic tumors. It is a rarer encephalic tumor. Because some tumor is benign in biology, it's possible that the tumor can be cured by surgery. But as a result of this region's depth, next to the important nerve, blood vessel and other important structure, the surgery is complex and difficult. Along with the micro neurosurgery's development, the application of CT and MRI diagnosis technology, the microsurgery treatment of pineal body area tumor has a significant improvement.Objective: To discuss the personal design of the therapeutic schedule in different cases through the 3D-CT image formation, choosing different approach before the operation and using the surgeon's experiences.Methods: Analyze 15 cases of pineal body area tumor treated in our hospital during 2000-2007, the main clinical symptoms including: 12 cases of headache, 10 cases of vomiting, 8 cases of eyesight decline or fuzzy vision, 2 cases of upper vision disabled, 4 cases of ataxia. Through 16 row of CT and (or) 1.5T MRI scanning, preliminarily analyze the position of tumor, the maximum diameter, and the important blood vessels which are next to the tumor. 2 cases were inspected by DSA, 11 cases were inspected by 3D-CT. The results showed that 7 cases were supratentorial,8 cases were infratentorial, All 15 cases were treated by operation under microscope. Based on the radiographic results, in 7 cases whose tumors'root located in tentorium and the major part of the tumor was supratentorial, we used the Poppen approach. In 8 cases whose tumors were infratentorial, and were not adhered to the Galen vein, we used the Krause approach.Result: In all 15 cases, the tumors were totally removed. The pathologic findings include meningioma(12 cases), glioma(2 cases) and ependymoma(1 case). 1 case died in perioperative period. 1 case got intracranial infection after the operation, and was cured through antibiotic therapy. After operations, all the patients'symptoms had been significantly improved, and it showed no adverse complications. The cases were followed-up between 4 months to 5 years, except 2 cases were lost contact with, all other patients recovered well. Based on the radiographic reexamination results, no evidence shows the tumor recurrence.Conclusion: Before the operation, we can use the 3D-CT and MRI examination; carry on the observations from different angles. We can get the information about the tumor's shape, growing direction, blood supply artery origins and the relationship to the cerebrum deep venous system, which can ensure a proper operative approach, the tumor can be totally removed and avoiding damage to the trunk vessel. When choosing approach, we followed such principles that the anatomy structure revealed clearly, the bridge vein can be maximum preserved, and the tumor can be totally removed. In Poppen approach, the patient is at left 3/4 prone posture. We realized the advantage of this approach is the occipital lobe can descend under the gravity which can reduce the distraction injury. During the operation, we recommend occipital puncture drainage of ventricles at first, emit proper amount of cerebrospinal fluid to reduce the intracranial pressure. In order to reduce the bleeding during operation, blocking the tumor's artery and envelope vessel is nessicery. When separating the root of the tumor, do not damage the vein of Galen which is perhaps wrapped by the tumor. In Krause approach, the patient is also at left 3/4 prone posture. So we can avoid damaging the deep venous system's vein complex and reducing the surgery complication.In brief, choose a reasonable approach, design a personal therapeutic schedule based on different cases, we can achieve the best clinical effectiveness.