Exploration of the pineal region: observations and results.

Experience with direct exploration of the pineal region in 22 consecutive patients is reported. Of these cases, mass lesions with obstructive hydrocephalus were found in 19; the remaining 3 had arteriovenous malformations of the pineal region. Of the 19 mass lesions, 5 (26%) were benign and curable. Although a preliminary shunt was routinely provided in all patients with obstructive hydrocephalus before exploration of the pineal region, the condition of five (26%) worsened after the shunt operation, requiring emergency decompression of the pineal tumor. A transtentorial approach through a right occipital craniotomy was uniformly employed in all cases. Overall mortality was less than 5%. These observations and results support the policy of direct exploration of all lesions in the pineal region.