Surgical Management of Pineal Region Lesions

The pineal region, situated at the junction of the midbrain and the third ventricle, is host to a variety of lesions including cysts, germ cell tumours, pineal parenchymal neoplasms and vascular malformations. Presentation often centres on obstructive hydrocephalus, raised intracranial pressure and Parinaud’s syndrome. Surgical management aims first to secure tissue diagnosis, alleviate cerebrospinal fluid obstruction and then achieve safe resection tailored to lesion type. Advances in neuroimaging and neuronavigation facilitate precise preoperative planning, while options range from endoscopic biopsy with third ventriculostomy to open microsurgical excision via infratentorial supracerebellar or occipital transtentorial corridors. Minimally invasive endoscope-assisted techniques have expanded indications for biopsy and limited resections, whereas traditional open approaches remain indispensable for achieving gross total removal in solid tumours. Multidisciplinary evaluation across neurosurgical, neuro­oncology and neuroradiology teams underpins decision making. Recent refinements focus on reducing surgical morbidity through refined patient positioning, avoidance of venous injury and preservation of midbrain structures. Collectively, these strategies have improved symptomatic relief, minimised complication rates and enhanced long-term outcomes in both adult and paediatric populations.

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Surgical Management of Pineal Region Lesions publication trend

The graph below shows the total number of articles in surgical management of pineal region lesions across all publications each year (not limited to Nature Index journals).

Technical terms

Pineal region lesions: Pathological entities arising in or around the pineal gland, including cysts and tumours.

Hydrocephalus: Accumulation of cerebrospinal fluid within the ventricles, leading to raised intracranial pressure.

Infratentorial supracerebellar approach: A posterior corridor beneath the tentorium and above the cerebellum for access to pineal lesions.

Endoscopic third ventriculostomy: Creation of an opening in the floor of the third ventricle to divert cerebrospinal fluid and relieve hydrocephalus.

Endoscope-assisted microsurgery: Integration of endoscopic visualization into open microsurgical procedures to enhance illumination and reduce brain retraction.

Gross total resection: Complete macroscopic removal of a lesion as judged by the operating surgeon.

References

1. Surgical treatment of symptomatic pineal cysts without hydrocephalus—meta-analysis of the published literature. Acta Neurochirurgica (2021).
2. Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach—surgical strategies, complications, and their avoidance. Neurosurgical Review (2022).
3. Endoscope-Assisted Microsurgery in Pediatric Cases With Pineal Region Tumors: A Study of 18 Cases Series. Frontiers in Surgery (2021).