Definition and Overview

Pinealectomy is a surgical procedure that removes the pineal gland when a pineal tumour, which could be benign or malignant, is detected. The pineal gland is a part of the endocrine system that is responsible for creating melatonin, a hormone that plays a huge role in the body’s circadian rhythm. Pineal tumours affect not only sleep but also hormone production and other metabolic processes in the body.

Like in other body conditions, pineal excision surgery isn’t always the immediate form of treatment for any issues affecting the gland. In the majority of cases, the neurologist recommends a wait-and-see approach, especially if the patient is asymptomatic. Another reason why surgery is considered as the last option is because pinealectomy is one of the most challenging surgical procedures because of the size and location of the gland. As such, the procedure’s benefits and disadvantages are carefully weighed before it is even recommended to a patient. In cases wherein the surgery is absolutely necessary, surgeons have the option to perform it using open or traditional technique although minimally invasive methods are now more preferred because they offer minimal recovery time and post-operative pain as well as less scarring.

Who Should Undergo and Expected Results

Pinealectomy is done on patients who are diagnosed with benign or malignant pineal tumour, which leads to the development of the following symptoms: consistent or recurrent headaches, nausea, vomiting, and abnormal levels of melatonin. Since the gland works together with other glands in the body, there may also be secondary manifestations like infertility or precocious puberty, a condition characterised by the appearance of secondary female sexual characteristics earlier than normal.

Pineal tumours are rare, which adds to the challenge of surgery. They make up no more than 2% of all neurosurgeries performed and the majority of cases tend to involve children 10 years old and below. Usually, childhood pineal tumours are cancerous.

The tumour may also occur along with other neurological conditions like hydrocephalus, or the buildup of cerebrospinal fluid (CSF) in the brain due to a possible blockage in the ventricles. Before pinealectomy can be performed, hydrocephalus is treated first with endoscopic third ventriculostomy (EVT) to drain CSF.

Pinealectomy reduces the size of the tumour and other therapies, such as chemotherapy and radiation therapy, are implemented to fully eradicate the abnormal growth.

How Does the Procedure Work?

Considering that pineal gland removal is a delicate procedure, the neurosurgeon exhausts all steps to obtain a complete medical record and imaging of the brain, usually with an MRI or CT scan. These also help the surgeon plan the approach depending on the location and size of the tumour, as well as the overall health of the patient.

The approach can be traditional or minimally invasive. In the more conventional method, a large incision or cut on the head is made to access the brain and regular surgical tools are used to excise the gland. If it’s minimally invasive, the surgeon is more likely to use an endoscope, a long narrow tube that can be inserted into a small incision. It features a light that illuminates the surgical area and a camera that delivers live images directly into a computer screen to guide the surgeon throughout the procedure. This approach normally requires three to four small cuts at the back of the ear where other microsurgical instruments are also inserted so the gland can be excised.

Regardless of the surgical approach, the procedure is performed under general anaesthesia and requires the patient to stay in the hospital for 5-7 days for close monitoring. Meanwhile, complete recovery can take up to six weeks depending on the size and location of the tumour, the overall health of the patient, and his unique circumstances.

Possible Risks and Complications

The biggest risk of pineal gland removal is brain injury. The stakes are higher if the approach is more invasive since it leaves a lot of room for the surgical instruments to damage the nearby tissues. It also increases the risk of excessive bleeding and infection.

Aside from controlling a person’s body clock, melatonin is also shown to have cancer-prohibitive properties. Thus, some studies suggest that the removal of the pineal gland increases the incidence of certain types of cancer like breast cancer.

References

  • Van Wagenen WP. A surgical approach for removal of certain pineal tumours: Report of a case. Surg Gynecol Obstet. 1931. 53:216.

  • Torkildsen A. Should extirpation be attempted in cases of neoplasms in or near the third ventricle of the brain? Experiences with a palliative method. Journal of Neurosurgery. 1948. 5:269.

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