Introduction: A surgeon’s experience at a single institution using the occipital interhemispheric surgical approach to lesions in the pineal region.
Methods: A restrospective chart review of 21 patients who underwent surgery in this area. This review looked at presenting symptoms, the length of hospital stay, post-operative neurologic deficits, disposition, and the need for a shunting device for the treatment of hydrocephalus.
Results: The cohort consisted of twenty one patients with ages ranging from 15 to 83 (mean 41) and shows a wide array of pathology and presenting symptoms. 18 of the patients were discharged home,and the average hospital stay was 9 days (range 3-34). There were no mortalities, and the morbidities included: new onset diabetes insipidus, and upward gaze palsy, one of which resolved at clinic follow-up. A total of eight patients had ventriculo-peritoneal shunts placed for hydrocephalus.
Conclusions: The surgical treatment of lesions in the pineal gland and posterior third ventricle evolved considerably over the last century. What was an operation associated with an almost prohibitive mortality and morbidity unacceptable by today’s standards, is now performed with good outcomes, little post-operative deficits, and a much shorter hospital stay. There are several routes to the pineal gland, the most common being the supracerebellar infratentorial and occipital transtentorial approaches. The present series is a single institution experience using occipital interhemispheric approach, with results showing an ability to treat a variety of lesions, with a relatively short hospital stay, and with minimal morbidity. This series highlights the improvement of neurosurgical techniques over the past few decades to the point where we are now proficient at treating lesions in this once surgically inaccessible area of the brain.
Patient Care: Advocate an approach to a difficult location that can be done safely with little patient harm.
Learning Objectives: 1) Understand the different approaches to the pineal region, 2) describe the different types of pathology that present in this area, and 3) know the morbidity that may result from operating in this part of the brain.