ELSEVIER Tumor NONRESECTIVE TREATMENT OF PINEOBLASTOMA: A CASE REPORT Arun-AngeIo Patil, M.D.*; Roger Good, M.D.t; Rifat Bashir, M.D.+; and Hamid Etemadrezaie, M.D.*5 *Division of Neurosurgery, University of Nebraska Medical Center, Omaha, Nebraska; TDepartment of Radiation Oncology, University of Nebraska Medical Center, Omaha, Nebraska; $Department of Internal Medicine (Neuro-Oncology), University of Nebraska Medical Center, Omaha, Nebraska; SDepartment of Neurosurgery, Mashhad University of Medical Sciences, Mashhad, Iran Patil A-A, Good R, Bashir R, Etemadrezaie H. Nonresective treat- ment of pineoblastoma: a case report. Surg Neurol 1995;44:386- 91. BACKGROUND Stereotactic biopsy followed by cytoreductive surgery and/or radiation are the standard treatment for pineo- blastoma. We are reporting a patient with a relatively large pineoblastoma, who was treated with a combina- tion of nonresective treatment modalities. METHOD The patient is a 20-year-old woman who presented with signs and symptoms of raised intracranial pressure. Mag- netic resonance imaging (MRI) showed a large tumor in the pineal region and hydrocephalus. She was emergently treated by placement of a ventriculoperitoneal shunt. Three days later she underwent a stereotactic biopsy, which showed the tumor to be pineoblastoma. She was then further treated with the following treatment modal- ities: permanent implantation of high activity Ilz5 seeds, external radiation, and chemotherapy. RESULTS At 10 months’ follow-up, MRI showed complete disap- pearance of the tumor. At 18 months’ follow-up, the pa- tient is asymptomatic, neurologically intact, and her MRI scans show no evidence of intracranial or intraspinal tumor. CONCLUSIONS Though the follow-up is relatively short, the results of the nonresective approach in this patient have been ex- cellent. KEY WORDS PineobLastoma, brachytherapy, external radiation, chemo- therapy. Address reprint requests to: Awn-Angelo Patil, M.D., Division of Neu- rosurgery, University of Nebraska Medical Center, 600 South 42 Street, Omaha, NE 68918-2035. Received November 8, 1994; accepted May 8, 1995. 0090-3019/95/$15.00 SSDI 0090-3019(95)00225(2 S hunting, external radiation, and chemotherapy were the main treatment options for pineal region tumors prior to the introduction of micro- neurosurgical techniques [6,8,14,27,29]. After the introduction of microneurosurgical techniques, bi- opsy or excision through open craniotomy were performed [l&22,31,32,34]. At the present time, computed tomography (CT) and magnetic reso- nance imaging (MRl) guided stereotactic biopsy of pineal region tumors is a routine procedure [l-5,9,19,20,21,23,26,28,33,36]. Following biopsy, based on the result of the pathology, microsurgical excision and/or external radiation and chemother- apy are the treatment options. In addition to these forms of treatment, some authors have also advo- cated brachytherapy [ 10,21,24] and radiosurgery [2,8,9]. Though the latter forms of treatment have been used for different types of pineal region tu- mors, it has not been reported for pineoblastomas. In this paper we are reporting a case of pineoblas- toma that was treated with high activity 1’25 per- manent seeds implant, external radiation of the cra- niospinal axis, and chemotherapy with excellent results. CASEREPORT The patient is a 20-year-old white woman, who pre- sented with a 4-month history of nausea, vomiting, headaches, intermittent diplopia, fatigue, and un- steady gait. She was drowsy, had bilateral papill- edema, and was unsteady on her feet. She had a full range of eye movement, and was free of focal neu- rologic deficit. MRI (Figure 1 A, B) showed a tumor of 49cm3 volume in the pineal region, which en- hanced with gadolinium, and a moderate degree of 0 1995 by ElsevIer Science Inc. 655 Avenue of the Americas, New York, NY 10010