Supratentorial and Infratentorial Approaches to Pineal Surgery: A Database AnalysisFunding The authors have not received any funding for this work.
25 May 2018
10 September 2018
25 October 2018 (online)
Objectives Neoplasms involving the pineal gland are rare. When they do occur, tumor resection is anatomically challenging and is traditionally addressed by either a supratentorial or an infratentorial approach. To date, no large, multicenter studies have been performed that systematically analyze outcomes comparing these two approaches. This study aimed to evaluate outcomes for patients undergoing pineal neoplasm resection, comparing supratentorial and infratentorial approaches.
Design Retrospective database review.
Setting Multi-institutional database.
Participants From 2005 to 2016, 60 patients were identified, with 13 undergoing a supratentorial approach and 47 undergoing an infratentorial approach.
Main Outcome Measures Patient demographics, comorbidities, and 30-day postoperative outcomes were investigated using the American College of Surgeons National Surgical Quality Improvement Program database. Demographics, readmission, reoperation, and complication rates were analyzed and compared with previous studies.
Results Patient demographics were similar between these two groups. The overall complication rates for the supratentorial and infratentorial approaches were 30.8 and 17%, respectively, and the difference was not statistically significant. The most common medical complications encountered were respiratory and hematological.
Conclusion As the first multi-institutional database analysis of approaches to the pineal gland, this study provides an analysis of patient demographics, comorbidities, and postoperative complications. After controlling for preoperative risk factors and demographic characteristics, no statistically significant differences in postoperative outcomes were found between infratentorial and supratentorial approaches. The mean readmission, reoperation, and complication rates were found to be 2.1, 8.3, and 20%, respectively. The lack of significant difference between approaches suggests that clinical decision-making should depend upon anatomical considerations and physician preference, although the complications illustrated here may provide some preoperative guidance.
- 1 Mottolese C, Szathmari A, Beuriat P-A. Incidence of pineal tumours. A review of the literature. Neurochirurgie 2015; 61 (2-3): 65-69
- 2 Choudhry O, Gupta G, Prestigiacomo CJ. On the surgery of the seat of the soul: the pineal gland and the history of its surgical approaches. Neurosurg Clin N Am 2011; 22 (03) 321-333 , vii
- 3 Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. Surg Neurol 2003; 59 (04) 250-268
- 4 Cho B-K, Wang K-C, Nam D-H. , et al. Pineal tumors: experience with 48 cases over 10 years. Childs Nerv Syst 1998; 14 (1-2): 53-58
- 5 Kieran MW, Walker D, Frappaz D, Prados M. Brain tumors: from childhood through adolescence into adulthood. J Clin Oncol 2010; 28 (32) 4783-4789
- 6 Kennedy BC, Bruce JN. Surgical approaches to the pineal region. Neurosurg Clin N Am 2011; 22 (03) 367-380 , viii
- 7 Chen L, Mao Y. Consensuses and controversies on pineal tumor surgery. World Neurosurg 2010; 74 (4-5): 446-447
- 8 Little KM, Friedman AH, Fukushima T. Surgical approaches to pineal region tumors. J Neurooncol 2001; 54 (03) 287-299
- 9 Qi S, Fan J, Zhang XA, Zhang H, Qiu B, Fang L. Radical resection of nongerminomatous pineal region tumors via the occipital transtentorial approach based on arachnoidal consideration: experience on a series of 143 patients. Acta Neurochir (Wien) 2014; 156 (12) 2253-2262
- 10 Hernesniemi J, Romani R, Albayrak BS. , et al. Microsurgical management of pineal region lesions: personal experience with 119 patients. Surg Neurol 2008; 70 (06) 576-583
- 11 Hart MG, Santarius T, Kirollos RW. How I do it--pineal surgery: supracerebellar infratentorial versus occipital transtentorial. Acta Neurochir (Wien) 2013; 155 (03) 463-467
- 12 Shiloach M, Frencher Jr SK, Steeger JE. , et al. Toward robust information: data quality and inter-rater reliability in the American College of Surgeons National Surgical Quality Improvement Program. J Am Coll Surg 2010; 210 (01) 6-16
- 13 Murphy M, Gilder H, McCutcheon BA. , et al. Increased operative time for benign cranial nerve tumor resection correlates with increased morbidity postoperatively. J Neurol Surg B Skull Base 2016; 77 (04) 350-357
- 14 Esfahani DR, Shah H, Arnone GD, Scheer JK, Mehta AI. Lumbar discectomy outcomes by specialty: a propensity-matched analysis of 7,464 patients from the ACS-NSQIP database. World Neurosurg 2018; 18: e865-e870
- 15 Bhimani AD, Denyer S, Esfahani DR, Zakrzewski J, Aguilar TM, Mehta AI. Surgical complications in intradural extramedullary spinal cord tumors - an ACS-NSQIP analysis of spinal cord level and malignancy. World Neurosurg 2018; 117 (00) e290-e299
- 16 Chaker AN, Bhimani AD, Esfahani DR. , et al. Epidural Abscess: a propensity analysis of surgical treatment strategies. Spine 2018 (e-pub ahead of print). Doi: 10.1097/BRS.0000000000002747
- 17 Chiu RG, Hobbs J, Esfahani DR. , et al. Anterior versus posterior approach for thoracic corpectomy: an analysis of risk factors, outcomes, and complications. World Neurosurg 2018; 116: e723-e732
- 18 Bhimani AD, Esfahani DR, Denyer S. , et al. Adult Chiari I malformations: an analysis of surgical risk factors and complications using an international database. World Neurosurg 2018; 115: e490-e500
- 19 Arnone GD, Esfahani DR, Papastefan S. , et al. Diabetes and morbid obesity are associated with higher reoperation rates following microvascular decompression surgery: an ACS-NSQIP analysis. Surg Neurol Int 2017; 8: 268
- 20 Arnone GD, Esfahani DR, Wonais M. , et al. Surgery for cerebellar hemorrhage: a National Surgical Quality Improvement Program database analysis of patient outcomes and factors associated with 30-day mortality and prolonged ventilation. World Neurosurg 2017; 106: 543-550
- 21 American College of Surgeons. . About ACS NSQIP. http://www.facs.org/quality-programs/acs-nsqip/about . Accessed July 28, 2018
- 22 Bruce JN, Stein BM. Surgical management of pineal region tumors. Acta Neurochir (Wien) 1995; 134 (3-4): 130-135
- 23 Fauchon F, Jouvet A, Paquis P. , et al. Parenchymal pineal tumors: a clinicopathological study of 76 cases. Int J Radiat Oncol Biol Phys 2000; 46 (04) 959-968
- 24 Kotwica Z, Saracen A, Kasprzak P. Keyhole surgery of pineal area tumors - personal experience in 22 patients. Transl Neurosci 2017; 8: 207-210
- 25 Choque-Velasquez J, Colasanti R, Resendiz-Nieves JC. , et al. Supracerebellar infratentorial paramedian approach in Helsinki neurosurgery: cornerstones of a safe and effective route to the pineal region. World Neurosurg 2017; 105: 534-542
- 26 Oliveira J, Cerejo A, Silva PS, Polónia P, Pereira J, Vaz R. The infratentorial supracerebellar approach in surgery of lesions of the pineal region. Surg Neurol Int 2013; 4: 154
- 27 Parker JJ, Waziri A. Preoperative evaluation of pineal tumors. Neurosurg Clin N Am 2011; 22 (03) 353-358 , vii–viii
- 28 Dahiya S, Perry A. Pineal tumors. Adv Anat Pathol 2010; 17 (06) 419-427
- 29 Yamamoto I, Kageyama N. Microsurgical anatomy of the pineal region. J Neurosurg 1980; 53 (02) 205-221
- 30 Choque-Velasquez J, Colasanti R, Resendiz-Nieves JC. , et al. Praying sitting position for pineal region surgery: an efficient variant of a classic position in neurosurgery. World Neurosurg 2018; 113: e604-e611