Controversies in multimodal treatment of pineal tumors: Experience of 84 cases

The pineal tumors represent one of the most difficult and challenging disease from all brain pathology due to the complex anatomy of the area and because of the diverse pathology of this type of tumors. The management of these tumors is multi modal and comprises the surgical approach followed by radiotherapy and chemotherapy. The authors present a large series of 84 consecutive operated cases of pineal tumors. All these cases have undergone one of the two main surgical approaches (occipito-transtentorial approach and supracerebellar - infratentorial approach). In 22 cases (26,1%) the tumor was totally removed, in 18 cases (21,4%) near total removal was obtained, in 33 cases (39,2%) partial removal and biopsy was performed in 11 cases (13,1%). From all 84 cases, 39 cases (46%) were germ cells tumors, 16 cases (19%) were pineal parenchyma tumors, in 27 cases (32%) were glial cell tumors and in 2 cases (3%) were miscellaneous tumors. As adjuvant therapy, radiotherapy played an important role within the multimodal management of pineal tumors. Therefore 61 cases have undergone the radiotherapy, which have been indicated for all sensitive tumors. The chemotherapy was applied in 41 cases, and consisted in a combination of cisplatin, bleomycin and actinomycin D. The outcome was good recovery in 56 cases (66%), moderate disability in 12 cases (14.7%), severe disability in 9 cases (10.2%) and death in 7 cases (8.8%).&nbsp