Pineal tumours

Tumours of the pineal are very rare, tend to be more common in children and while there are a wide variety of pathologies the majority are germ cell tumours and pineal parenchymal tumours. These tumours usually present with hydrocephalus and endoscopic third ventriculostomy is the operation of choice. It is important to test for tumour markers in the blood and cerebrospinal fluid, since the diagnosis of a secreting germ cell tumour precludes the need for surgery. Surgical biopsy can be performed by endoscopy or with frame-based stereotaxy. For germ cell tumours chemotherapy and radiotherapy are the mainstay of treatment, but surgery has a role in the management of residual disease. For primary parenchymal tumours, maximum surgical resection is the first-line treatment and can be curative for pineocytoma. Pineoblastoma require adjuvant radiotherapy and for intermediate grade pineal tumours the role of radiotherapy is still being evaluated.