Surgery of Pineal and Pineal Region Tumors: Alternative Approaches to Pineal Tumors: How to Do It.

Alternative approaches can be used when pineal tumors extend into the third ventricle or the lateral ventricles.For tumors that develop in the posterior cerebral fossa, a combined supra- and infratentorial approach can be proposed.An anterior avenue for lesion of the third ventricle and the pineal region using a frontal transcallosal approach was proposed by Apuzzo in 1992. A posterior parietal transventricular approach had already been proposed by Van Vagenen in 1931 and later by Jomin in 1980, through the ventricular crossroads, allowing lateral exposure of the venous structures, the tumor, and the pineal region. The choice between a frontal transcortical transventricular approach or an interhemispheric transcallosal transventricular approach continues to fuel discussion today, with consideration of their respective advantages and disadvantages.The presence of hydrocephalus and the potential risks of behavioral or memory disturbances due to the damage to the body or the pillars of the fornix are important factors in the decision-making process.All the approaches described have advantages and disadvantages that the surgeon must evaluate in order to ensure the best option for the patient, taking into account the size and extent of the lesion as well as the possibility of avoiding sequelae.Surgeons interested in pineal region surgery must be familiar with several approaches, although in practice, each surgeon usually chooses the approach with which they are most experienced.