Tumors of pineal cell origin

Tumors of pineal cell origin are rare intracranial lesions. They are the second most common entity encountered in the pineal gland, after tumors of germ cell origin. They are classified according to their differentiation in pineocytomas (World Health Organization [WHO] grade I tumor), pineal parenchymal tumors of intermediate differentiation, papillary tumors of the pineal region, and pineoblastomas (WHO grade 4 tumor). Differentiation between pineal and germ cell tumors is essential, and for this purpose serum and cerebrospinal fluid (CSF) markers are used, alongside imaging techniques. Often, the only way to differentiate these two types of tumors is through a biopsy, which may be carried out with or without a simultaneous third ventriculocisternostomy. Retrospective series show an association between the extent of resection and improved outcomes, and benign lesions may be cured by performing a gross total resection. However, the approaches to this region are highly complex, because of the plethora of essential neuroanatomical structures in the area. The approaches need to be tailored to the specific anatomy of the patient and should aim at minimizing surgical morbidity. Because of their complexity, these lesions should mainly be performed in centers with sufficient experience in the treatment of pineal region lesions.</p

The use of clinical examination and cranial ultrasound in the diagnosis and management of post-hemorrhagic ventricular dilation in extremely premature infants.

© 2017 Nature America, Inc., part of Springer Nature. Objectives: The objective of this study is to describe clinical and ultrasound changes in a cohort of premature newborns with post-hemorrhagic ventricular dilation (PHVD), and to correlate these changes with outcome. Study Design: Premature newborns \u3c29 weeks gestational age (GA) and ≤ 1,500 g birth weight with intraventricular hemorrhage were retrospectively reviewed. Clinical signs and cranial ultrasound (CUS) findings between time after birth and time before first cerebrospinal fluid temporizing intervention were compared with GA-equivalent newborns without interventions. White matter injury was assessed on brain magnetic resonance imaging. Results: Between 2011 and 2014, 64 newborns met inclusion criteria; 23% had PHVD. The growth rates of the ventricles on CUS and the head circumference (HC) were higher in newborns with PHVD (p \u3c 0.01 and p = 0.04, respectively) and correlated inversely with white matter injury (p = 0.006 and p \u3c 0.001, respectively). Conclusion: Progression of PHVD in premature newborns as demonstrated by CUS and the HC correlated with outcome. Consistent measurement of these simple parameters will allow for much needed treatment comparisons, to define optimal protocols that decrease the risk of cerebral palsy in extremely preterm populations