Management of primary intracranial germinomas: diagnostic surgery or radical resection?

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✓ Because intracranial germinomas are readily curable with radiation and chemotherapy or radiation therapy alone, the role of radical surgery has become debatable. This study assesses the optimum degree of surgical resection for intracranial germinomas.

Twenty-nine patients who underwent surgery for germinoma were retrospectively analyzed (male/female ratio 27:2, median age 18 years). Among these 29 patients there were 10 solitary pineal, seven solitary neurohypophyseal/hypothalamic, and 12 multifocal or disseminated tumors. Biopsy samples were obtained in 16 patients (stereotactically in eight, transsphenoidally in four, and via frontotemporal craniotomy in four). Partial resection was attained in five patients (via a frontotemporal approach in three and occipitotranstentorially in two). Gross-total resection was achieved via an occipitotranstentorial route in eight patients with pineal masses. After surgery, 10 patients were treated with radiotherapy alone, and 19 received radiation and chemotherapy; complete remission was achieved in all 29 patients. The overall tumor-free survival rate was 100% at a median follow-up period of 42 months. There was no significant difference in outcome related to the extent of surgical resection. Postoperative neurological improvement was seen in only two patients, whereas transient postoperative complications, mainly upgaze palsy, were observed in six. One patient experienced a slight hemiparesis, bringing the surgical morbidity rate to 3% (one of 29).

It is concluded that radical resection of intracranial germinomas offers no benefit over biopsy. The primary goal of surgery should be to obtain a sufficient volume of tumor tissue for histological examination. If there is strong evidence of germinoma on radiological studies, biopsy samples should be obtained. When a perioperative histological diagnosis of pure germinoma is made during craniotomy, no risk should be taken in continuing the resection.

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Address reprint requests to: Nicolas de Tribolet, M.D., Service de Neurochirurgie de L'HCUG du CHUV, CH-1011 Lausanne, Switzerland.

© AANS, except where prohibited by US copyright law.

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References

  • 1.

    Allen JCDaRosso RCDonahue Bet al: A phase II trial of preirradiation carboplatin in newly diagnosed germinoma of the central nervous system. Cancer 74:9409441994Allen JC DaRosso RC Donahue B et al: A phase II trial of preirradiation carboplatin in newly diagnosed germinoma of the central nervous system. Cancer 74:940–944 1994

    • Search Google Scholar
    • Export Citation
  • 2.

    Baskin DSWilson CB: Transsphenoidal surgery of intrasellar germinomas. Report of two cases. J Neurosurg 59:106310661983Baskin DS Wilson CB: Transsphenoidal surgery of intrasellar germinomas. Report of two cases. J Neurosurg 59:1063–1066 1983

    • Search Google Scholar
    • Export Citation
  • 3.

    Bruce JNStein BM: Surgical management of pineal region tumors. Acta Neurochir 134:1301351995Bruce JN Stein BM: Surgical management of pineal region tumors. Acta Neurochir 134:130–135 1995

    • Search Google Scholar
    • Export Citation
  • 4.

    Chandrasoma PTSmith MMApuzzo MLJ: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:1601651989Chandrasoma PT Smith MM Apuzzo MLJ: Stereotactic biopsy in the diagnosis of brain masses: comparison of results of biopsy and resected surgical specimen. Neurosurgery 24:160–165 1989

    • Search Google Scholar
    • Export Citation
  • 5.

    Cohen DNSteinberg MBuchwald R: Suprasellar germinomas: diagnostic confusion with optic gliomas. Case report. J Neurosurg 41:4904931974Cohen DN Steinberg M Buchwald R: Suprasellar germinomas: diagnostic confusion with optic gliomas. Case report. J Neurosurg 41:490–493 1974

    • Search Google Scholar
    • Export Citation
  • 6.

    Committee of the Brain Tumor Registry of Japan: Incidence of primary tumors (1969–1983). Neurol Med Chir 32 (No. 7 special issue):3951992Committee of the Brain Tumor Registry of Japan: Incidence of primary tumors (1969–1983). Neurol Med Chir 32 (No. 7 special issue):395 1992

    • Search Google Scholar
    • Export Citation
  • 7.

    Dearnaley DPA'Hern RPWhittaker Set al: Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18:7737811990Dearnaley DP A'Hern RP Whittaker S et al: Pineal and CNS germ cell tumors: Royal Marsden Hospital experience 1962–1987. Int J Radiat Oncol Biol Phys 18:773–781 1990

    • Search Google Scholar
    • Export Citation
  • 8.

    de Tribolet NBarrelet L: Successful chemotherapy of pinealoma. Lancet 2:122812291977 (Letter)de Tribolet N Barrelet L: Successful chemotherapy of pinealoma. Lancet 2:1228–1229 1977 (Letter)

    • Search Google Scholar
    • Export Citation
  • 9.

    Edwards MSBHudgins RJWilson CBet al: Pineal region tumors in children. J Neurosurg 68:6896971988Edwards MSB Hudgins RJ Wilson CB et al: Pineal region tumors in children. J Neurosurg 68:689–697 1988

    • Search Google Scholar
    • Export Citation
  • 10.

    Epstein FMCooper KRWard JD: Profound pulmonary shunting without edema following stereotaxic biopsy of hypothalamic germinoma. Case report. J Neurosurg 68:3033071988Epstein FM Cooper KR Ward JD: Profound pulmonary shunting without edema following stereotaxic biopsy of hypothalamic germinoma. Case report. J Neurosurg 68:303–307 1988

    • Search Google Scholar
    • Export Citation
  • 11.

    Freilich RJThompson SJWalker RWet al: Adenocarcinomatous transformation of intracranial germ cell tumors. Am J Surg Pathol 19:5375441995Freilich RJ Thompson SJ Walker RW et al: Adenocarcinomatous transformation of intracranial germ cell tumors. Am J Surg Pathol 19:537–544 1995

    • Search Google Scholar
    • Export Citation
  • 12.

    Fujimaki TMatsutani MFunada Net al: CT and MRI features of intracranial germ cell tumors. J Neurooncol 19:2172261994Fujimaki T Matsutani M Funada N et al: CT and MRI features of intracranial germ cell tumors. J Neurooncol 19:217–226 1994

    • Search Google Scholar
    • Export Citation
  • 13.

    Herrmann HDWestphal MWinkler Ket al: Treatment of nongerminomatous germ-cell tumors of the pineal region. Neurosurgery 34:5245291994Herrmann HD Westphal M Winkler K et al: Treatment of nongerminomatous germ-cell tumors of the pineal region. Neurosurgery 34:524–529 1994

    • Search Google Scholar
    • Export Citation
  • 14.

    Hoffman HJOtsubo HHendrick EBet al: Intracranial germ-cell tumors in children. J Neurosurg 74:5455511991Hoffman HJ Otsubo H Hendrick EB et al: Intracranial germ-cell tumors in children. J Neurosurg 74:545–551 1991

    • Search Google Scholar
    • Export Citation
  • 15.

    Horowitz MB: Central nervous system germinomas. A review. Arch Neurol 48:6526571991Horowitz MB: Central nervous system germinomas. A review. Arch Neurol 48:652–657 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Huh SJShin KHKim IHet al: Radiotherapy of intracranial germinomas. Radiother Oncol 38:19231996Huh SJ Shin KH Kim IH et al: Radiotherapy of intracranial germinomas. Radiother Oncol 38:19–23 1996

    • Search Google Scholar
    • Export Citation
  • 17.

    Itoyama YKochi MKuratsu Jet al: Treatment of intracranial nongerminomatous malignant germ cell tumors producing α-fetoprotein. Neurosurgery 36:4594661995Itoyama Y Kochi M Kuratsu J et al: Treatment of intracranial nongerminomatous malignant germ cell tumors producing α-fetoprotein. Neurosurgery 36:459–466 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Jenkin DBerry MChan Het al: Pineal region germinomas in childhood. Treatment considerations. Int J Radiat Oncol Biol Phys 18:5415451990Jenkin D Berry M Chan H et al: Pineal region germinomas in childhood. Treatment considerations. Int J Radiat Oncol Biol Phys 18:541–545 1990

    • Search Google Scholar
    • Export Citation
  • 19.

    Jennings MTGelman RHochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:1551671985Jennings MT Gelman R Hochberg F: Intracranial germ-cell tumors: natural history and pathogenesis. J Neurosurg 63:155–167 1985

    • Search Google Scholar
    • Export Citation
  • 20.

    Kiltie AEGattamaneni HR: Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital, 1972–1993. Med Pediatr Oncol 25:4504561995Kiltie AE Gattamaneni HR: Survival and quality of life of paediatric intracranial germ cell tumour patients treated at the Christie Hospital 1972–1993. Med Pediatr Oncol 25:450–456 1995

    • Search Google Scholar
    • Export Citation
  • 21.

    Kleihues PBurger PCScheithauer BW: Histological Typing of Tumors of the Central Nervous Systemed 2. Vienna: Springer-Verlag1993Kleihues P Burger PC Scheithauer BW: Histological Typing of Tumors of the Central Nervous System ed 2. Vienna: Springer-Verlag 1993

    • Search Google Scholar
    • Export Citation
  • 22.

    Linstadt DWara WMEdwards MSBet al: Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15:2912971988Linstadt D Wara WM Edwards MSB et al: Radiotherapy of primary intracranial germinomas: the case against routine craniospinal irradiation. Int J Radiat Oncol Biol Phys 15:291–297 1988

    • Search Google Scholar
    • Export Citation
  • 23.

    Matsumoto KHigashi HTomita Set al: Pineal region tumours treated with interstitial brachytherapy with low activity sources (192-iridium). Acta Neurochir 136:21281995Matsumoto K Higashi H Tomita S et al: Pineal region tumours treated with interstitial brachytherapy with low activity sources (192-iridium). Acta Neurochir 136:21–28 1995

    • Search Google Scholar
    • Export Citation
  • 24.

    Nazzaro JMShults WTNeuwelt EA: Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76:7467511992Nazzaro JM Shults WT Neuwelt EA: Neuro-ophthalmological function of patients with pineal region tumors approached transtentorially in the semisitting position. J Neurosurg 76:746–751 1992

    • Search Google Scholar
    • Export Citation
  • 25.

    Rainov NGHolzhausen HJBurkert W: Complete disappearance of giant intracranial germinoma after irradiation. Neurosurg Rev 18:2852921995Rainov NG Holzhausen HJ Burkert W: Complete disappearance of giant intracranial germinoma after irradiation. Neurosurg Rev 18:285–292 1995

    • Search Google Scholar
    • Export Citation
  • 26.

    Régis JBouillot PRouby-Volot Fet al: Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery 39:9079141996Régis J Bouillot P Rouby-Volot F et al: Pineal region tumors and the role of stereotactic biopsy: review of the mortality morbidity and diagnostic rates in 370 cases. Neurosurgery 39:907–914 1996

    • Search Google Scholar
    • Export Citation
  • 27.

    Sakai NYamada HAndoh Tet al: Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors. Acta Oncol 27:42501988Sakai N Yamada H Andoh T et al: Primary intracranial germ-cell tumors. A retrospective analysis with special reference to long-term results of treatment and the behavior of rare types of tumors. Acta Oncol 27:42–50 1988

    • Search Google Scholar
    • Export Citation
  • 28.

    Sano K: So-called intracranial germ cell tumours: are they really of germ cell origin? Br J Neurosurg 9:3914011995Sano K: So-called intracranial germ cell tumours: are they really of germ cell origin? Br J Neurosurg 9:391–401 1995

    • Search Google Scholar
    • Export Citation
  • 29.

    Sawamura Y: Current diagnosis and treatment of central nervous system germ cell tumors. Curr Opin Neurol 9:4194231996Sawamura Y: Current diagnosis and treatment of central nervous system germ cell tumors. Curr Opin Neurol 9:419–423 1996

    • Search Google Scholar
    • Export Citation
  • 30.

    Shibamoto YAbe MYamashita Jet al: Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:2852901988Shibamoto Y Abe M Yamashita J et al: Treatment results of intracranial germinoma as a function of the irradiated volume. Int J Radiat Oncol Biol Phys 15:285–290 1988

    • Search Google Scholar
    • Export Citation
  • 31.

    Shokry AJanzer RCVon Hochstetter ARet al: Primary intracranial germ-cell tumors. A clinicopathological study of 14 cases. J Neurosurg 62:8268301985Shokry A Janzer RC Von Hochstetter AR et al: Primary intracranial germ-cell tumors. A clinicopathological study of 14 cases. J Neurosurg 62:826–830 1985

    • Search Google Scholar
    • Export Citation
  • 32.

    Sievers ELBerger MGeyer JR: Long-term survival of a patient with primary sellar choriocarcinoma with pulmonary metastases: a case report. Med Pediat Oncol 26:2932951996Sievers EL Berger M Geyer JR: Long-term survival of a patient with primary sellar choriocarcinoma with pulmonary metastases: a case report. Med Pediat Oncol 26:293–295 1996

    • Search Google Scholar
    • Export Citation
  • 33.

    Stein BM: Supracerebellar approach for pineal region neoplasms in Schmidek HSweet W (eds): Operative Neurosurgical Technique. New York: Grune & Stratton1982 Vol 1 pp 599607Stein BM: Supracerebellar approach for pineal region neoplasms in Schmidek H Sweet W (eds): Operative Neurosurgical Technique. New York: Grune & Stratton 1982 Vol 1 pp 599–607

    • Search Google Scholar
    • Export Citation
  • 34.

    Sumida MUozumi TKiya Ket al: MRI of intracranial germ cell tumours. Neuroradiology 37:32371995Sumida M Uozumi T Kiya K et al: MRI of intracranial germ cell tumours. Neuroradiology 37:32–37 1995

    • Search Google Scholar
    • Export Citation
  • 35.

    Wara WMJenkin RDTEvans Aet al: Tumors of the pineal and suprasellar region: Children's Cancer Study Group treatment results 1960–1975. A report from Childrens' Cancer Study Group. Cancer 43:6987011979Wara WM Jenkin RDT Evans A et al: Tumors of the pineal and suprasellar region: Children's Cancer Study Group treatment results 1960–1975. A report from Childrens' Cancer Study Group. Cancer 43:698–701 1979

    • Search Google Scholar
    • Export Citation
  • 36.

    Wilson JTWald SLAitken PAet al: Primary diffuse chiasmatic germinomas: differentiation from optic chiasm gliomas. Pediatr Neurosurg 23:161995Wilson JT Wald SL Aitken PA et al: Primary diffuse chiasmatic germinomas: differentiation from optic chiasm gliomas. Pediatr Neurosurg 23:1–6 1995

    • Search Google Scholar
    • Export Citation
  • 37.

    Wolden SLWara WMLarson DAet al: Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32:9439491995Wolden SL Wara WM Larson DA et al: Radiation therapy for primary intracranial germ-cell tumors. Int J Radiat Oncol Biol Phys 32:943–949 1995

    • Search Google Scholar
    • Export Citation
  • 38.

    Xu WLZhang BChen Tet al: Treatment of intracranial germinoma. Chinese Med J 108:3673691995Xu WL Zhang B Chen T et al: Treatment of intracranial germinoma. Chinese Med J 108:367–369 1995

    • Search Google Scholar
    • Export Citation
  • 39.

    Yoshida JSugita KKobayashi Tet al: Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir 120:1111171993Yoshida J Sugita K Kobayashi T et al: Prognosis of intracranial germ cell tumours: effectiveness of chemotherapy with cisplatin and etoposide (CDDP and VP-16). Acta Neurochir 120:111–117 1993

    • Search Google Scholar
    • Export Citation

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