The pineal gland is a centrally located, midline structure which may give rise to a variety of different tumors. In the past, pineal region tumors have been traditionally treated with an empiric 'test dose' of radiotherapy and a CSF shunt. A pineal region tumor that 'responded' by decreasing in size was then given a full course of radiation. This type of treatment plan is no longer widely used.
Surgery is more common today.
A tumor of the pineal gland typically presents with headache, nausea, vomiting, and double vision. There are many different histologic types of pineal region tumors. Many of these may disseminate throughout the craniospinal axis and therefore, standard evaluation of these patients should include surgical confirmation of the pathology and contrast-enhanced spine MRI scans as well as CSF cytology studies. Radical surgery relieves elevated intracranial pressure and may contribute to a cure. The preferred surgical approach depends upon the exact anatomic features of the pineal region tumor and is individualized for each patient.