Neurosurgery clinics of North America
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The pineal region can harbor highly diverse histologic tumor subtypes. Because optimal therapeutic strategies vary with tumor type, an accurate diagnosis is the foundation of enlightened management decisions. ⋯ Biopsy has the advantage of ease and minimal invasiveness but is associated with more sampling errors than open surgery. The emergence of endoscopic techniques and stereotactic radiosurgery provide complementary options to improve pineal tumor management, and will assume greater importance in the neurosurgeon's armamentarium.
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The present review assesses how to make pineal surgery, refined over decades, better, ie, less invasive, while still respecting this delicate region, and achieving anatomic and oncologic goals. An explication of anatomic principles of this region, and some basic surgical principles of keyhole surgery are provided to further assist those interested in minimizing surgical impact during pineal surgery. Although this review, for the sake of brevity, focuses on the infratentorial-supracerebellar approach, many of these principles can be adapted to other approaches, such as the occipital transtentorial, without excessive imagination.