Pineal TumorA Malignant Form Of Pineal Tumor Is Called Pineoblastoma.
Pineal tumors arise in the region of the pineal gland. This gland is a small structure deep within the brain. These tumors represent about 1% of all brain tumors but account for 3% to 8% of the intracranial tumors that occur in children. At least 17 different types of tumors may occur in this region, and many are benign.
The three most common types of pineal region tumors are: -
- germ cell tumors
- pineal cell tumors.
Pineal Tumor Causes
As with most brain tumors, the cause of pineal tumors is largely unknown. Research is underway to discover the possible causes.
- Nausea and vomiting
- Double vision
- Memory problems
- A magnetic resonance imaging (MRI) of the brain is the most important imaging study. It will show the location, size, and shape of the tumor.
- A computed tomography (CT) scan of the brain may be helpful to see if the tumor is calcified.
- Both MRI and CT scans assess for the amount of hydrocephalus.
- In many cases, a biopsy is required to determine the tumor type.
- More than a dozen different types of tumor occur in this region. UCLA neurosurgeons have expertise in minimally invasive techniques (endoscopy or stereotactic needle biopsy) for obtaining biopsies.
- If the diagnosis of germinoma is suspected based on the MRI scan as well as the age and sex of the patient (young male), a biopsy may not be required prior to beginning treatment.
- Other tests
- Some tumors that occur in the pineal region have high levels of certain chemicals (Beta-HCG, AFP, and CEA), which can be detected in the cerebrospinal fluid and/or blood. If detected, a surgical biopsy may not be necessary.
An MRI scan shows a large tumor (arrow) in the pineal region of the brain. The biopsy confirmed glioblastoma, which is rare in this part of the brain. This illustrates the importance of obtaining a tissue biopsy in most cases.
Surgery is standard treatment when possible. Radiation therapy may be used as primary treatment in adults and children above age three. Chemotherapy may be given to delay the use of radiation therapy in very young patients. A shunt may be needed to treat hydrocephalus caused by blockage of the ventricles. Treatment for high-grade (malignant) pineal tumors such as a pineoblastoma may involve radiation to the brain and spine to control spread through the CSF. Clinical trials using chemotherapy or biological therapy following radiation therapy are being investigated.
- Surgical Removal
- The surgical removal of pineal region tumors ranks among the most difficult neurosurgical operations. Patients typically are referred to major university medical centers, like UCLA, where certain neurosurgeons have specific expertise in this type of surgery.
- Although surgery can be curative in some cases, in other cases it provides a definitive diagnosis and reduces the size of the tumor.
- Whenever possible, UCLA neurosurgeons use minimally-invasive surgical techniques
- Surgical Management of Hydrocephalus
- UCLA neurosurgeons have extensive expertise in the minimally invasive, endoscopic treatment of hydrocephalus. Typically, this can be done by an endoscopic third ventriculostomy. In other cases, a shunt may be necessary.
- Radiation therapy
- More than 70 percent of tumors are highly sensitive to radiation therapy.
- In many cases, stereotactic Radiosurgery can provide excellent control of pineal tumors. UCLA uses the advanced Novalis shaped-beam stereotactic radiosurgery system, which is equally or more effective than Gamma Knife.
- The choice is dependent on the type of tumor and the patient.
- Many tumor types need both radiation and chemotherapy.
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