Komal Naeem1, Zunaira Saeed2, Afia Salman2, Malaika Jawaid1, Shilpa Golani1, Haseeb Mehmood Qadri3, Hamza Khan4, Khawaja Muthammir Hassan5, Syed Ather Enam6
1Section of Neurosurgery, Department of Surgery, Aga Khan University, Karachi, Pakistan;
2Department of Surgery, Dow University of Health Sciences, Karachi, Pakistan;
3Department of Neurosurgery, Punjab Institute of Neurosciences, Lahore, Pakistan;
4Rawalpindi Medical University, Rawalpindi, Pakistan;
5Department of Surgery, King Edward Medical University, Lahore, Pakistan;
6Centre of Oncological Research in Surgery, Aga Khan University, Karachi, Pakistan
Correspondence to: Syed Ather Enam, MBBS, PhD. Centre of Oncological Research in Surgery, Aga Khan University Hospital, National Stadium Road, Karachi, Sindh 74800, Pakistan. Email: ather.enam@aku.edu.
Background: Attributing to its deep-seated location, surrounded by significant vessels, surgical management of pineal gland lesions is still considered a challenge. Various surgical approaches are employed to access these lesions, based on patient-specific risks and benefits. Each approach has its merits and demerits. In this study, we aim to narrate our experience with trans-cortical trans-ventricular (TT) approach for pineal tumor resection. We aim to outline the procedure details, safety, efficacy, and treatment outcome of TT.
Case Description: This is a single-center, consecutive case series. All patients with pineal gland tumors who underwent surgical intervention, namely biopsy or resection using TT approach from 2000 to 2023 were included. Data for the patient characteristics, intraoperative details and complications were collected from the hospital’s database. Mean [standard deviation (SD)] and frequency (proportions) were calculated for continuous and discrete variables, respectively. We identified 13 patients, mean age 24 (SD: 13) years in our case series. Of them, 8 (61.5%) were male. Most common presenting complains were headaches (69%), nausea/vomiting (38.5%), seizure (23%), and visual deficit (23%). Most patients, 60%, had high grade tumor and average size of tumors were 43.5 mm (SD: 18.45 mm). Pilocytic astrocyotma (23%) and pineal parenchymal tumor of intermediate differentiation (23%) were the most common diagnoses. In total, nine patients had pineal gland lesion biopsy done using TT approach along with the cerebrospinal fluid (CSF) diversion. Of them, four had tumor resection done using the same approach. Whereas four patients had primary excision done using TT approach. There were no intra-operative complications. Two patients had post-operative seizures which were treated with anti-epileptics. We did not identify any long-term sequalae attributed to this approach.
Conclusions: We presented our data regarding the safety, efficacy, and outcomes of trans-cortical trans-ventricular approach for pineal tumor surgical management. Utilizing this novel approach for pineal lesion resection can be a great addition to surgeons’ armamentarium. This unique approach allows to access the tumor for biopsy/resection and perform CSF diversion procedure, simultaneously. Moreover, the same incision can be used for the second/redo surgery.
Keywords: Hydrocephalus; pineal region; trans-cortical trans-ventricular (TT) approach; tumor biopsy; case series
