Children who show symptoms of a pineal region tumor (or any brain tumor) should be evaluated first with a thorough physical and neurological exam by his or her pediatrician. The pediatrician may refer the child for imaging studies to get a look at what may be causing the symptoms or blood tests to look for markers to identify the type of tumor.
Magnetic resonance imaging (MRI) and computerized tomography (CT) scans produce detailed images of the brain and spine and allow doctors to detect the presence of a tumor. They are much more detailed than X-rays. Both of these tests are noninvasive, but they do require time in a scanner to produce tiny slices of images that are then combined into three-dimensional pictures. Sometimes the child will need a special contrast agent in advance to increase the visibility of any abnormality found. MRI scans are also important tools in determining the relationship of the tumor to the adjacent structures. Many times a spine MRI will be included to assess for any spread of the tumor.
Blood tests are essential in the diagnostic evaluation of a patient with a pineal region tumor. Tumor markers in the blood can frequently confirm the diagnosis of a germ cell tumor. Identifying these markers are important in creating a treatment plan for the patient.
A spinal tap might be recommended to measure tumor markers or look for any spread of the tumor, particularly in young children. This test should never be done before obtaining a CT or MRI of the brain to determine if hydrocephalus is present. Many times this test is postponed until the hydrocephalus is treated.
Surgical biopsies may help a pediatric neurosurgeon determine the exact nature of the tumor. During a biopsy, the neurosurgeon will extract a small sample of abnormal cells to test in a pathology laboratory. An accurate diagnosis can be difficult, but it’s important to pinpoint the exact type of tumor a child has in order to create the most effective treatment plan.
Minimally invasive endoscopic surgery has revolutionized the approach to performing pineal tumor biopsies. Endoscopic surgery, the preferred method of biopsy, offers a much less risky alternative to conventional surgical approaches. Endoscopic biopsy should be performed at that time of the original diagnosis and can be done in a fraction of the time that was needed for older surgical procedures.
In some cases, though, a neurosurgeon may operate to remove the tumor and send a tissue sample to the laboratory at that time, sparing the patient a second surgery.
As with many other brain tumors, pineal region tumors are best treated with surgery. The surgery, called resection, removes all or part of the tumor — the more tumor that’s removed the better the prognosis for recovery. These surgical procedures are highly involved and can take several hours. However the surgical management is safe and is no longer associated with the degree of risk that once complicated these types of surgery (see Surgery for a Pineal Region Tumor).
Brain tumors of the pineal region are complex and should be treated at a major medical center with advanced facilities and capabilities, by highly trained specialists with expertise in treating these tumors (see Doctors Who Treat Pineal Region Tumors).
Reviewed by: Mark Souweidane, MD
Last reviewed/last updated: April 2022