Children & families · Conditions
Pineal region tumours
Tumours near the pineal gland, deep in the centre of the brain. Treatment depends greatly on the tumour type, which blood and fluid tests can sometimes identify without surgery.
What is it?
The pineal gland lies deep in the centre of the brain, near the pathway that drains fluid from the brain. Several kinds of tumour can occur here, including germ cell tumours (germinoma and non-germinomatous germ cell tumours), pineal parenchymal tumours such as pineoblastoma, and gliomas. Small fluid-filled pineal cysts are common, usually harmless, and often found by chance; they rarely need treatment.
What symptoms can it cause?
Because these tumours often block the flow of fluid, children may have headaches, vomiting and drowsiness from hydrocephalus. Pressure on the nearby midbrain can cause difficulty looking upwards and other eye-movement problems (Parinaud syndrome). Some children have hormone changes, such as early puberty or excessive thirst.
How is it assessed?
An MRI scan of the brain and spine shows the tumour. Blood and spinal fluid are tested for tumour markers (alpha-fetoprotein and beta-hCG), which can identify some germ cell tumours without the need for surgery, and spinal fluid may be checked for tumour cells. The case is discussed at the multidisciplinary tumour board.
What are the treatment options?
Treatment depends on the type. Hydrocephalus is often treated first with an endoscopic third ventriculostomy (ETV), and at the same time a biopsy of the tumour can often be taken endoscopically. Germinomas respond very well to chemotherapy and radiotherapy and are often cured without major surgery. Other tumours may need surgical removal, followed by chemotherapy and/or radiotherapy with the oncology team.
When might surgery be considered?
Surgery may be considered to treat hydrocephalus, to obtain a diagnosis when markers are not conclusive, or to remove the tumour when this is the best treatment. The options, benefits and risks are discussed with you in detail.
What to expect from recovery and follow-up
Recovery depends on the operation. After an ETV and biopsy, most children are in hospital for a few days; after open removal, longer. Follow-up includes regular MRI scans, tumour markers where relevant, eye checks, and hormone monitoring.
When to seek urgent help
If your child is very drowsy, difficult to wake, has a seizure, repeated vomiting or a severe headache, go to the nearest emergency unit or call 10177. If your child is under our care, also call the hospital switchboard and ask for Dr Labuschagne (Netcare Unitas Hospital 012 677 8000; Nelson Mandela Children's Hospital 010 133 0600).
This page is general information for parents and caregivers. Your child's doctor will advise on what applies to your child.