• Joham Choque-Velasquez, Julio Resendiz-Nieves, Behnam Rezai Jahromi, Roberto Colasanti, Rahul Raj, Juho Vehviläinen, Olli Tynninen, Juhani Collan, Mika Niemelä, and Juha Hernesniemi.
• Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: johchove@hotmail.com.
• World Neurosurg. 2019 Nov 1; 131: e379-e391.

BackgroundPineal region tumors represent challenging surgical lesions with wide ranges of survival reported in different surgical series. In this article, we emphasize the role of complete microsurgical resection (CMR) to obtain a favorable long-term outcome of pineal region tumors.MethodsWe report a retrospective study of pineal region tumors operated on in Helsinki Neurosurgery between 1997 and 2015. Information was obtained from the hospital records, and an evaluation of the Finnish population register was conducted in July 2018 to determine the current status of the patients.ResultsA total of 76 pineal region tumors were operated on. The survival was 62% at a mean follow-up of 125 ± 105 months (range, 0-588 months), and the disease-related mortality was limited to 14 patients (18.4%). Up to July 2018, 29 patients had died. Two patients died 1 and 3 months after surgery of delayed thalamic infarctions, 12 patients of disease progression, and 15 had non-disease-related deaths. Only 1 patient was lost in the long-term follow-up. Ten of 14 disease-related deaths occurred during the first 5 years of follow-up: 5 diffuse gliomas, 3 germ cell tumors, 1 grade II-III pineal parenchymal tumor of intermediate differentiation, and 1 meningioma. CMR was linked to better tumor-free survival and long-term survival, with the exception of diffuse gliomas.ConclusionsCMR, in the setting of a multidisciplinary management of pineal region tumors, correlates with favorable survival and with minimal mortality. Surgically treated grade II-IV gliomas constitute a particular group with high mortality within the first 5 years independently of the microsurgical resection.Copyright © 2019 Elsevier Inc. All rights reserved.

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