Surgical Treatment of Pineal Region Tumours Through the Occipital Transtentorial Approach: Evaluation of the Effectiveness of Intra-Operative Micro-Endoscopy Combined with Neuronavigation

Summary

 Object. To determine the efficacy and accuracy of surgically-assisted systems including endoscopy combined with neuronavigation in the treatment of pineal region tumours through the occipital transtentorial approach, an evaluation of thirty-one patients undergoing surgery was performed over a 10-year period.

 Method. The study was performed in 2 parts. The surgical approach to the pineal region was the same in the two parts, but in part 2 a smaller craniotomy window was used. Part 1 (from March 1989 to March 1997) included 15 patients who underwent surgical removal of pineal region tumours without using assisted systems; four out of the fifteen patients had surgery-related complications, including seizure and hemianopsia. Part 2 (from April 1997 to February 1999) included 16 patients who underwent surgical treatment by the same surgical team and with assisted systems; all 16 patients had excellent outcomes, with no complications.

 Conclusions. Although this study was the first specifically to examine the efficacy of endoscopy combined with neuronavigation in the treatment of pineal region tumours, our findings suggest that these systems are very useful, safe, and accurate in evaluating the primary tumour and surrounding anatomy as well as in determining operative strategy, such as the location and size of the scalp incision, craniotomy, and the extent of surgical removal. Therefore, we conclude that the addition of endoscopy combined with neuronavigation to standard surgical procedures can improve the outcome of surgical treatment of pineal region tumours.