Diagnosis and Treatment of Pinealoma

Oh, Y H; Chang, K H; Choo, D W

Abstract

It is well established that pinealoma is radiocurable disease entity, but it is very harzardous even to obtainbiopsy material because of its location and it has been suggested that after the surgical intervention to thepinealoma intraventricular seeding as well as hematogenous metastasis is frequent. Sp tp give radiation therapywithout pathological confirmation, accurate diagnosis must be made on the clinical bases. The purpose of thispaper is how to make accurate diagnosis on the clinical bases and how to treat the pinealoma. During 7 years fromMay 1968 to May 1975 total 11 cases of pinealoma were met at the Department of Radiology in Seoul NationalUniversity Hospital. Clinical and radiological findings, and the result of treatment are analized. The resultsobtained are as follows : 1. All patients are male and age distribution is localized to the 2nd 3rd decades. 2.Most common chief complaint is increased intracranial pressure signs such as headache and vomiting. impairment ofconiugated upward gaze (Parinaud's syndrome) is noticed in 9 cases, and absence or diminishment of light reflexand papilledema are present in majority. Endocrinologic abnormalities are another characteristic finding sodiabetes inspidus and precoxious puberty are noticed in 7 cases and 2 cases respectively. 3. Simple skull showsincreased intracranial pressure signs in 6 cases and abnormal pineal calcification in 7 cases which are displaceddownward and posteriorly in all cases. 4. Carotid angiography is done in 9 cases, which shows enlargement of thelateral ventricle in all cases and changes of internal cerebral vein in 4 cases. 5. Vertebral angiography is donein 3 cases, which shows bowing, approximation and superolateral displacement of posterior choroidal arteries inall case and abnormal tumor staining and vascularization in 2 cases. 6. Ventriculography is the most valuablediagnostic procedure and usually confirmative, of which typical finding is well demarcated tumor mass located inposterior portion of 3rd ventricle. Besides complication Conray ventriculography is superior to thepneumoventriculography in visualization and determination of pineal tumor. 7. The most desirable treatmentschedule is radiation therapy after simple shunt operation.