© 2004 by Society
© 2004 by the Society forNeuro-Oncology
Refining the staging evaluation of pineal region germinoma usingneuroendoscopy and the presence of preoperative diabetes insipidus
Departments of Pediatrics (A.T.R., H.A., K.W.B.), Surgery, Section of Pediatric Neurosurgery (J.C.W.,P.A.G.), and Radiation Oncology (J.B.F.), Universityof Alabama at Birmingham, Birmingham, AL 35233; and Departments of Neurology and Pediatrics, Beth IsraelMedical Center (J.C.A.), New York, NY 10128; USA
2 Address correspondence to Alyssa T. Reddy, 1600 7th Avenue South, ACC 512, TheChildren's Hospital of Alabama, Birmingham, AL 35233, USA(AReddy{at}peds.uab.edu).
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Abstract |
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Treatment strategies for CNS germinoma are currently evolving. Currentapproaches include reducing the volume and dose of radiation by addingpre-irradiation chemotherapy. Very accurate staging is necessary with such anapproach to prevent failures. Eight consecutive patients with pineal germinomaat one institution underwent endoscopic surgery for tumor biopsy, directvisualization of the third ventricular region, and third ventriculostomy forthose with hydrocephalus. All patients were treated with 4 cycles ofchemotherapy. Conformal field radiation therapy followed, with the dose to thetumor bed dependent on the response to chemotherapy. Patients who had MRI,endoscopic, or cerebrospinal fluid evidence of multicentric or disseminateddisease also received craniospinal radiation. Six patients had diabetesinsipidus (DI) at presentation. All 6 had tumor studding the floor of thethird ventricle on endoscopic visualization, while only 4 of those patientshad MRI evidence of disease in that region. All patients have completedtherapy and are alive, with no evidence of disease at median follow-up of 31.5months from diagnosis. Direct endoscopic visualization of the thirdventricular region may be more sensitive than MRI for evaluating the presenceof suprasellar disease and appears to add important information. Thisparameter should be added to the staging evaluation when feasible. In thisseries, the presence of DI was 100% predictive of suprasellar disease, evenwhen the MRI was negative for involvement of that region. Patients should beevaluated for DI as part of the initial staging, and if it is present, thepatients should be treated for suprasellar disease regardless of MRIfindings.
Received May 30, 2003; Accepted December 3, 2003
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