الفهرس | Only 14 pages are availabe for public view |
Abstract Tumors located in the pineal gland region are rare neo- plasms, constituting 0.5–1 % of all intracranial tumors. The treatment for the pineal region tumors depends on tumor histology. Nowadays, germinomas can be cured by radiotherapy and chemotherapy without surgical resection but the other pineal region tumors should be primary treated by surgery. Two microsurgical approaches, the infratentorial supracerebellar and the occipital transtentorial, are accepted as the main standard accesses to the pineal region. Serum and CSF markers contribute to the diagnosis of pineal parenchymal tumors. CT and MRI arw used in diagnosis of pineal tumor. The treatment recommendations are as follows: 1- Pinoblastoma: Treated like medulloblastoma with maximal safe resection to determine risk category, then CSI (23.4-39 Gy + local boost to 50-55.8 Gy )followed by chemotherapy. Radiosurgery boost possible for residual disease. 2- Pineocytoma: Treat like low- grade glioma. Surgery when possible. If gross total resection, observe if increasing , postopreative RT (residual+1-1.5cm margin)50-55 Gy. Summary - 78 - 3- Germinoma: MRI of new axis. RT alone or chemotherapy followed by RT. prophylactic new axis RT is controversial. Consider partial cranial fields, whole ventricular irradiation to (24-30Gy), boost to primary to (45-50Gy). If there is new axis or sub ependymal spread, or multiple mid line tumor CSI (24-36Gy)+ primary disease to (45-50Gy). 4- NGGCTs: Maximal safe resection then platinum based chemotherapy. MRI and lumber puncture, if negative new axis , consolidation local RT. If positive new axis, CSI 30- 36 Gy + boost to primary disease 50-54 Gy |