Abstract
BACKGROUND AND OBJECTIVE: Pineal region tumors are rare intracranial lesions accounting for less than one percent, with heterogeneous histopathology. Despite the existing literature, gaps remain in understanding the comprehensive management and long-term outcomes of pineal tumors, particularly within the Pakistani context. We aimed to provide a comprehensive overview of pineal region lesions, their clinical and radiological presentation, and their management outcomes in a resource-limited setting. Methodology: Thirty-two patients with pineal tumors who underwent surgical procedures at Punjab Institute of Neurosciences (PINS) between 2022 and 2024 were enrolled. RESULTS: The study included 32 patients, out of which 68.8% (22) were males and 31.3%(10) were females with a mean age of 24.1±12.3 years (mean ± standard deviation). The most common presentation was headache in 87.5% (28). All patients presenting Glasgow coma scale (GCS) was between 13-15, and mean pre-operative Karnofsky performance status (KPS) was 90.6 ± 11.6. The lesion was hypodense in 81.3% (26) on computed tomography (CT). On magnetic resonance imaging (MRI), 34.4% (11) were hypointense on T1 weighted images, 90.6% (29) were hyperintense on T2 weighted images, and 53.1% (17) was homogenously enhanced on contrast. Among all, 40.6% (13) had surgical excision, 46.9% (15) underwent biopsy, and 6.3% (2) underwent cerebrospinal fluid (CSF) diversion surgery. On histopathology, 21.9% (7) were pineocytomas, 21.9% (7) were germinomas and 12.5% (4) were pineoblastomas. Postoperatively, 93.7% (30) had a GCS of 13-15, with a mean post-operative KPS of 91.5% ±15. Post-operative weakness occurred in 6.2% (2) and CSF leak occurred in 3.1% (1) patients. CONCLUSION: Pineal tumors require early diagnosis and a multidisciplinary approach for a good prognosis and better quality of life. Continued integration of minimally invasive techniques, neuronavigation, and multidisciplinary care is essential for optimizing outcomes in this rare and diverse tumor group.