Radical operation of pineal body tumor； with special reference to a follow-up study of a case of pineal body teratoma four and a half years after complete extirpation, and to a discussion of operative method

Out of 8 verified cases of pineal body tumors, 6 were operated upon for radical treatment and 4 were done total extirpation by the authors. A follow-up study was made of a ease of pineal body teratoma, 15g in weight, which was completely extirpated with Dandys transcallosal approach four and a half years ago when the patient was 7 years of age. The boy not only grew in body length, girth of head and chest, body weight, but also in intelligence as is befitting a child of his age. He complained neither pressure syndrome, visual disturbance, motor and sensory disturbances, precocious puberty nor paralysis of upward gaze. He had, however, convulsive attacks a few times a year and seizure waves from right temporoparietal region in EEG were observed. Left inferior homonimous quadrantanopsia and right slight ptosis and midriasis were observed. Operative methods were discussed, and summarizing as follows： Dandys transcallosal approach is useful for small pinealoma, but it is unconvenient that the Galens vein is located just in front of tumor in operative field. Van Wagenens transventricular approach was the first choice for the operation of a comparatively big pinealoma, because it was easy to separate Galens vein from the tumor, since the vein was visible lateral to the tumor. Residual symptoms after cortical incision of nondominant parietooccipital region after Van Wagenens approach, was negligibly small to act as an impediment for social life. Horraxs approach with occipital lobectomy was necessary in order to remove a large tumor. Hypothermia and postoperative temporary ventricular drainage produced satisfactory results for the radical operation of pinealoma.