Pineal region tumors begin in or near the pineal gland, a small endocrine gland in the center of the brain that regulates circadian rhythms. There are two primary categories of pineal region tumors: germ cell tumors and pineal parenchymal tumors. Other types of tumors can also appear in the pineal region because it contains many cell types found throughout the brain.
Pineal parenchymal tumors – These rare tumors arise directly from the cells of the pineal gland (pineocytes) and can occur at any age. They can be non-cancerous (benign pineocytomas), cancerous (malignant pineoblastomas) or share features of both.
Germ cell tumors – While not related to the pineal gland itself, these rare tumors occur in the pineal region near the pituitary gland. Caused by the abnormal migration of cells during the earliest development of the patient’s body during pregnancy, these tumors commonly appear by adolescence. They can be benign teratomas, dermoid and epidermoid tumors, malignant germinomas, choriocarcinomas, endodermal sinus tumors, embryonal cell tumors, or mixed tumor types.
Pineal region tumors are diagnosed through a neurological examination followed by a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the brain. MRI scans are usually performed with contrast dye to help identify the tumor’s size, location and type as well as the presence of hydrocephalus.
Depending on the type of tumor, an entire-spine MRI or a lumbar puncture can be performed to get cerebrospinal fluid. This can reveal the tumor type, determines if the tumor has spread to the spine and informs our treatment plan.
In other cases, an exact diagnosis can only be confirmed after a biopsy or surgical removal of the tumor. Biochemical markers in the blood and cerebrospinal fluid differentiate the various tumor subtypes. Tissue analysis by a neuropathologist defines the diagnosis and genetic profile of the tumor.
Treatment for pineal region tumors typically starts with surgical removal of the tumor. We use the latest techniques to make craniotomy (surgical opening of the skull) as safe and effective as possible. These include:
For some benign tumors, complete removal is curative, and the only follow-up needed is careful monitoring for recurrence.
However, surgery to remove malignant tumors is often followed by chemotherapy or radiation therapy. The diagnosis and molecular profile of each tumor is individually reviewed by our multi-disciplinary tumor board after surgery. Together, our experts recommend the best personalized and targeted treatment options incorporating the latest molecular diagnostics, treatment protocols and participation in national clinical trials.