Abstract
A wide variety of lesions occur in the pineal region. Of these, only 25% may benefit
from surgical resection, being benign or radioresistant in nature. In the remaining
75% (malignant or radiosensitive), a conservative approch is preferred. Surgical resection
of lesions arising from the pineal region has been associated with high morbidity
and mortality, due to the complex microanatomy of this area. Recently computer-assisted
surgery has emerged as an ideal method to safely approach many intracranial lesions.
In the present study we discuss our experience in interactive imageguided surgical
management of pineal mass lesions, in terms of patient selection, methodology, and
surgical morbidity and mortality. From July 1992 to December 1996, 15 patients underwent
interactive image guided surgical procedures. There were eight men and seven women.
Age ranged from 5 to 79 years (mean 30). Preoperatively all patients underwent neuroimaging
studies that included computed tomography and magnetic resonance imaging under stereotactic
conditions. Surgical planning was carried out using the Neurological Surgical Planning
System Software developed at Wayne State University. In patients with a preoperative
diagnosis of a malignant or radiosensitive lesion (n = 10), an interactive image-guided
stereotactic biopsy was considered, whereas for those with benign or radioresistant
lesions (n = 5) surgical excision using an infrared based System was carried out.
Histological diagnosis was obtained in all patients. There was no morbidity and mortality
associated with computer-assisted procedures for biopsies the diagnostic yield was
100%. For patients that underwent interactive image-guided surgery, gross total removal
was accomplished in 3 and in 1 patient a subtotal resection greater than 90% was achieved.
Interactive image-guided biopsy represents a safe and accurate method in the diagnosis
of malignant and/or radiosensitive pineal lesions. Using this technique surgeons can
simulate preoperatively the surgical trajectory, thus avoiding damage to critical
and vascular structures. For patients with benign or radioresistant lesions, computer-assisted
surgical excision is recommended.
Key words
Biopsy - Infrared - Interactive image-guided surgery - Pineal region - Stereotactic
