Introduction: Neoplasms involving the pineal gland are extremely rare. When they do arise, pineal gland tumor resections pose an anatomically difficult surgery that can be approached either supratentorally or infratentorally. Furthermore, these patients often present with a high American Society for Anesthesiology (ASA) class. To date, no large-scale multi-centered analysis of patient demographics and outcomes examining these two approaches has been performed. In this study, we evaluate and compare outcomes for patients undergoing pineal gland neoplasm resections via supratentorial and infratentorial approaches across multiple surgical centers.
Methods: Patient demographics, comorbidities, and 30-day post-operative outcomes were investigated utilizing the American College of Surgeons National Quality Improvement Program database.
Results: 60 patients from 2005-2016 were identified undergoing pineal gland surgery, with 13 representing supratentorial approach and 47 representing infratentorial approach. Patient demographics were similar between these two groups with the exception of a significantly higher percentage of smokers among supratentorial patients, and notable for a high percentage of advanced ASA class. The overall complication rate among both approaches was 20.0%, with a trend towards more frequent complications among patients undergoing the supratentorial approach. The most common type of complication for both approaches were respiratory and hematologic.
Conclusions: As the first multi-institutional study analyzing pineal gland tumor resection approaches, we provide an objective study on patient demographics, comorbidities, and post-operative complications. Ultimately, there were no significant differences between the two approaches, and postoperative outcomes were similar. Of note, the majority of patients were between the ages of 16 and 35, had an advanced ASA class, and required substantial post-operative stays, with the supratentorial approach requiring a 2.2-day longer stay compared to the infratentorial approach
Patient Care: A central challenge to studying approaches to the pineal gland is its rarity, limiting research to single institution or single surgeon centers. This research improves care by providing a contemporary, national "snapshot" of surgery for the pineal gland, and compares supratentorial and infratentorial techniques. These finding have the potential to guide decision making by surgeons and allow them to better council patients on risks and set expectations for their hospital stay.
Learning Objectives: By the conclusion of this session, participants should be able to:
1) Describe and compare supratentorial and infratentorial approaches to pineal gland tumors.
2) Identify and contrast the average complication rates for both supratentorial and infratentorial techniques.
3) Characterize and counsel pineal gland tumor patients on surgical risks and expectations for their hospitalization.