Ophthalmological outcome after resection of tumors based on the pineal gland

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Descriptions of visual dysfunction in pineal gland tumors tend to focus on upward gaze palsy alone. The authors aimed to characterize the nature, incidence, and functional significance of ophthalmological dysfunction after resection of tumors based on the pineal gland.


Review of a retrospective case series was performed and included consecutive patients who underwent surgery performed by a consultant neurosurgeon between 2002 and 2011. Only tumors specifically based on the pineal gland were included; tumors encroaching on the pineal gland from other regions were excluded. All patients with visual signs and/or symptoms were reviewed by a specialist consultant neuroophthalmologist to accurately characterize the nature of their deficits. Visual disturbance was defined as visual symptoms caused by a disturbance of ocular motility.


A total of 20 patients underwent resection of pineal gland tumors. Complete resection was obtained in 85%, and there were no perioperative deaths. Visual disturbance was present in 35% at presentation; of those who had normal ocular motility preoperatively 82% had normal motility postoperatively. In total, 55% of patients had residual visual disturbance postoperatively. Although upward gaze tended to improve, significant functional deficits remained, particularly with regard to complex convergence and accommodation dysfunction. Prisms were used in 25% but were only ever partially effective. Visual outcome was only related to preoperative visual status and tumor volume (multivariate analysis).


Long-term visual morbidity after pineal gland tumor resection is common and leads to significant functional impairment. Improvement in deficits rarely occurs spontaneously, and prisms only have limited effectiveness, probably due to the dynamic nature of supranuclear ocular movement coordination.

Abbreviations used in this paper:EORTC QLQ C-30 and BN-20 = European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 and Brain Module; QOL = quality of life.

Article Information

Address correspondence to: Michael G. Hart, M.B.Ch.B., Department of Neurosurgery, Addenbrooke's Hospital, Box 166, Cambridge CB2 0QQ, United Kingdom. email: mikehart82@me.com.

Please include this information when citing this paper: published online May 10, 2013; DOI: 10.3171/2013.3.JNS122137.

© AANS, except where prohibited by US copyright law.



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    Presentation and management of hydrocephalus. ETV = endoscopic third ventriculostomy; EVD = external ventricular drain; VPS = ventriculoperitoneal shunt.

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    Tumor locations as seen on MRI. Left: An epidermoid tumor demonstrating clearly its intimacy to the pineal gland. Right: An astrocytoma unequivocally based primarily on the pineal gland itself.

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    Kaplan-Meier plot demonstrating overall survival for the cohort. Three patients died at a mean of 14 months postoperatively. There are 17 long-term survivors. Mean survival has not been reached since the majority of patients are still alive. All patients had at least 12 months of follow-up (mean 36 ± 26 months).

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    Postoperative ophthalmological outcome. Each symbol represents a patient and his or her concordant ophthalmological status. The arrows demonstrate changes between groups. All other patients remained within their group. On univariate analysis, preoperative ophthalmological status significantly predicted postoperative ophthalmological status (p < 0.005, chi-square test).

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    Quality of life. The numbers in parentheses reflect the relative section of the EORTC QLQ C-30 or BN-20 questionnaire from which the answers were derived. For all parameters except 29 and 30 the scale was: 1, not at all; 2, a little; 3, quite a bit; 4, very much. For 29 and 30 the scales ranged from 1 (very poor) to 7 (excellent). The only significant difference related to double vision (36). *p < 0.05 (ANOVA). ADLs = activities of daily living.

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    Tumor volume and risk of visual deterioration.



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