Pineal tumour is the development of abnormal growth in the pineal gland or in the nearby area. The pineal gland is a small, cone shaped structure in the midline region of brain located at the back side to the third ventricle. The pineal gland secretes neurotransmitters called melatonin which regulates the circadian rhythm of the body. The gland contributes to a variety of cells such as parenchymal cells, endothelial cells, glial cells and germ cells. The diversity of cells in the gland presents tumours of different cellular origin in the gland. Pineal cell tumours are those that arise in the parenchymal cells involved in the image stimulus processing. The pineal tumours are termed as pineocytoma which are slow and benign and pineoblastomas which are malignant and aggressive.
- Hydrocephalus due to increased pressure on the skull
- Disruption in hormonal production and release
- Nausea and Vomiting
- Changes in vision
- Gradual loss of memory
The symptoms of brain tumour at initial stages are not regular and difficult to diagnose as other diseases also cause similar symptoms. The neurologist may perform neurological exam to detect the abnormality in vision, balance, hearing, reflexes and coordination.After the neurological test the doctor may suggest for other tests such as:
- Computerized Tomography Scan (CT) - The CT scan generates two dimensional brain images using high power X-rays which is connected to a computer. The patient has to lie on a movable table while taking the images. A tracer dye will be injected through I.V route after a few initial CT scan images. The dye will make the tumours more visible, which often takes less than 10 min.
- Magnetic Resonance Imaging Scan (MRI) - The scan uses radio waves and magnetic field to generate the brain images. The patient has to stay inside a cylindrical machine for 15 min to 60 min. MRI scans outline the soft tissues of the body and also bone which are most widely useful in diagnosing brain tumours. A special dye will be injected into the bloodstream which makes tumours to distinguish from healthy tissue.
- Head and Skull X- ray- Head X rays will be done to detect alterations in skull bone. It also detects hydrocephalus condition associated with brain tumour. In some cases it may also detect the calcium deposits associated with the tumour. Although X-rays are routinely performed, the test is less sensitive than other imaging tests.
- Angiogram - A special dye will be injected into the blood stream which flows through the blood vessels in the brain to detect the blood vessels in and around the tumour.
- Other Tests - such as:
- The other tests such as magnetic resonance spectroscopy (MRS), positron emission tomography (PET), single-photon emission computerized tomography (SPECT) scans will able to analyse the brain activity by investigating the brain chemistry and metabolism.
- The scans along with MRI scans will be helpful to understand the function and brain activity but cannot be used in primary diagnosis of the tumour.
- The absolute test to diagnose the brain tumours is biopsy. The biopsy can be taken to collect a small part of brain tissue such as needle biopsy which can be done with the help of CT scan or the part of the tissue removed as a part of surgery.
- The tissue analysis will detect the type of tumour, grade of tumour and also help to determine the treatment
- Cerebrospinal fluid test to detect the presence of certain chemicals such as Beta-HCG, AFP etc.
- Blood test should be required to detect the markers in blood.
- Surgery is the first line treatment for the pineal tumours. Though it is challenging to remove a tumour from the pineal region of brain but the recent advancements in surgery have made it a successful treatment option.
- The surgery called craniotomy is performed by a neurosurgeon where a portion of the skull is removed to get access to the tumour site and excised. If hydrocephalus is detected shunt is placed before the surgery.
- The aim of surgery is to completely remove the tumour while preserving the nearby tissue. The benign pineal tumours will be cured after complete resection but the malignant tumours are difficult for total resection resulting in subtotal resection which improves the effectiveness of adjuvant treatments.
Chemotherapy and Radiation
- In some patients tumour still remains after the surgery, mostly the malignant type. At such times, chemotherapy and radiotherapy is given.
- The neurosurgeon will decide which treatment will be effective after the surgery for complete cure.
- The germinomas also called as germ cell tumours and pineoblastomas respond well to the radiotherapy.
- The non germinomotous and pineoblastomas are treated with chemotherapy. However chemotherapy administration for brain tumours is not well studied.
- Pineal cysts which are asymptomatic do not require immediate therapy and are kept under observation.