eMedicine Specialties > Neurosurgery > Neoplasm

Pineal Tumors: Follow-up

Author: Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Coauthor(s): Benjamin Kennedy,, Columbia University College of Physicians and Surgeons; Alfred T Ogden, MD, Assistant Professor, Department of Neurological Surgery, Columbia University Medical Center; Richard C Anderson, MD, Staff Physician, Department of Neurological Surgery, Columbia University College of Physicians and Surgeons
Contributor Information and Disclosures

Updated: Dec 8, 2008

Outcome and Prognosis

The prognosis for patients with pineal region tumors is dependent upon tumor histology and is subject to change as more effective adjuvant therapy is developed. In general, patients with intracranial germinomas have an excellent prognosis because of the radiosensitivity of these tumors.

Children with nongerminomatous germ cell tumors have a significantly worse prognosis than do children with germinomas or pineal cell tumors. No conventional approach is designed for managing recurrence. Chemotherapy, radiotherapy, or radiosurgery can be applied if maximal doses have not already been administered. A second surgical procedure is generally reserved for patients with benign lesions who demonstrate recurrence several years later.

Recurrent germ cell tumors have been shown to respond to chemotherapy, as have some pineal cell tumors, although to a lesser degree. Radiosurgery may be a consideration for all recurrences less than 3 cm in diameter.

Future and Controversies

Pineal region tumors represent a rare but challenging problem for the neurologist, neurosurgeon, and clinical oncologist. Therapeutic and diagnostic advances in several disciplines have significantly improved the prognosis of patients with these lesions. The authors remain hopeful that current clinical and basic science research will help refine therapies and further augment survival rates while lowering morbidity.

 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors Andrew T Parsa, MD, PhD, and Chris E Mandigo, MD.



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References
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Further Reading

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Keywords

pineal, tumors, pineal tumor, pineal tumors, pineal gland, pineal gland tumors, pineal gland tumor, pineal region tumors, pineoblastomas, pineocytomas, pineal germ cell tumors, germinomas, pineal gliomas, pineal metastasis, obstructive hydrocephalus, vertical gaze palsy, astrocytomas, meningiomas, teratomas, pineal cyst, pineal cysts

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Contributor Information and Disclosures

Author

Jeffrey N Bruce, MD, Edgar M Housepian Professor of Neurological Surgery Research, Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons
Jeffrey N Bruce, MD is a member of the following medical societies: American Association for the Advancement of Science, American Association of Neurological Surgeons, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Society for Neuro-Oncology, and Southwest Oncology Group
Disclosure: NIH Grant/research funds Other

Coauthor(s)

Benjamin Kennedy,, Columbia University College of Physicians and Surgeons
Disclosure: Nothing to disclose.

Alfred T Ogden, MD, Assistant Professor, Department of Neurological Surgery, Columbia University Medical Center
Alfred T Ogden, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, and Congress of Neurological Surgeons
Disclosure: Nothing to disclose.

Richard C Anderson, MD, Staff Physician, Department of Neurological Surgery, Columbia University College of Physicians and Surgeons
Richard C Anderson, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

Michael G Nosko, MD, PhD, Chief, Division of Neurosurgery, Director of Neurovascular Surgery, Medical Director of Neuroscience Unit, Associate Professor, Department of Surgery, University of Medicine and Dentistry of New Jersey
Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

Allen R Wyler, MD, Former Medical Director, Northstar Neuroscience, Inc
Allen R Wyler, MD is a member of the following medical societies: American Academy of Neurological and Orthopaedic Surgeons, American Association of Neurological Surgeons, and Society of Neurological Surgeons
Disclosure: Nothing to disclose.

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