Evaluation of the Perioperative and Postoperative Course of Surgery for Pineal Germinoma in the SIOP CNS GCT 96 Trial

SIMPLE SUMMARY: There are many studies that discuss pineal tumors (not specifically germinoma). Some advocate for biopsy over resection due to the fact that germinoma is radio- and chemosensitive; others advocate for primary resection due to multiple differential diagnoses that require resection in the pineal region, such as pineocytoma, teratoma, meningioma, epidermoid, etc. However, with respect to solitary pineal germinoma, there is still no study that analyzes and compares both surgical options regarding peri- and postoperative courses and complications. We evaluated the perioperative course and postoperative complications of patients with isolated pineal germinoma who underwent a primary biopsy or resection, treated according to the European SIOP CNS GCT 96 trial. The key finding of our study was that postoperative complications, including hydrocephalus, Parinaud syndrome, double vision, etc., were significantly higher in patients who underwent primary resection (p < 0.008). ABSTRACT: Background: CNS germinoma, being marker-negative, are mainly diagnosed by histological examination. These tumors predominantly appear in the suprasellar and/or pineal region. In contrast to the suprasellar region, where biopsy is the standard procedure in case of a suspected germ-cell tumor to avoid mutilation to the endocrine structures, pineal tumors are more accessible to primary resection. We evaluated the perioperative course of patients with pineal germinoma who were diagnosed by primary biopsy or resection in the SIOP CNS GCT 96 trial. Methods: Overall, 235 patients had germinoma, with pineal localization in 113. The relationship between initial symptoms, tumor size, and postoperative complications was analyzed. Results: Of 111 evaluable patients, initial symptoms were headache (n = 98), hydrocephalus (n = 93), double vision (n = 62), Parinaud syndrome (n = 57), and papilledema (n = 44). There was no significant relationship between tumor size and primary symptoms. A total of 57 patients underwent primary resection and 54 underwent biopsy. Postoperative complications were reported in 43.2% of patients after resection and in 11.4% after biopsy (p < 0.008). Biopsy was significantly more commonly performed on larger tumors (p= 0.002). Conclusions: These results support the practice of biopsy over resection for histological confirmation of pineal germinoma.