Clinico-radiological, Histological, and Evolutionary Aspects of Pineal Parenchymal Tumors

Introduction: Pineal parenchymal tumors (PPT) are rare intracranial tumors arising in the pineal gland and represent a heterogeneous group with varied histological subtypes, such as pineocytomas, intermediate differentiation tumors, and pineoblastomas. Due to their deep location and diversity, PPTs pose diagnostic and therapeutic challenges. This study analyzes 13 cases to provide insights into the clinical, radiological, and pathological characteristics of PPTs treated over 25 years across two neurosurgery centers in Tunisia.

Methods: This retrospective, bicentric study included patients who underwent surgery for PPTs from 1996 to 2021 at two neurosurgery centers in Tunisia. Data on patient demographics, clinical presentation, radiological findings, surgical techniques, histopathological results, and outcomes were collected and analyzed.

Results: Demographics: The average patient age was 29 years (range: 21 months to 64 years), with a slight male predominance (53.8% male).
Clinical Presentation: Intracranial hypertension symptoms were the most common, affecting 77% of patients, with headaches reported in 77% and visual disturbances in 69.2%.
Radiological Findings: MRI was the primary imaging modality, revealing a heterogeneous lesion in most cases. Hydrocephalus was present in 76.9% of cases, and calcifications were detected in 15.4%.
Surgical and Adjuvant Treatment: Surgery was the main treatment, with 61.5% of cases requiring ventriculocisternostomy to manage hydrocephalus. Radiotherapy was administered to 38.5% of patients, and chemotherapy was used in select cases.
Pathology: Histological types included pineocytomas and pineoblastomas, with high-grade tumors displaying more aggressive behavior.

Conclusion : Pineal parenchymal tumors, though rare, require a tailored approach combining surgery, radiotherapy, and, in some cases, chemotherapy. The study highlights the importance of early intervention and multidisciplinary management for improved outcomes in PPT cases. Further studies with larger sample sizes are needed to refine treatment protocols for these complex tumors.