Outcomes and Surgical Approaches for Pineal Region Tumors in Adults: A Retrospective Study of a Single-Center Over 12 Years

<b>Background</b> Pineal region tumors are considered rare, deeply located, and very difficult to resect. They can cause various symptoms by compressing and obstructing different structures. Contradictory data have been reported regarding various aspects of surgical outcomes in different patient positioning. <b>Objectives</b> This retrospective study aimed to describe the variety of pineal region tumors and patient positioning in pineal region surgeries and compare the neurological outcomes during different approaches. <b>Materials and Methods</b> From January 1, 2010, to December 31, 2022, 61 patients with pineal area tumors were hospitalized at the National Center for Neurosurgery. Thirty-five patients' histology examinations were available. Twenty-nine patients had open surgical excision. Regarding approaches, supracerebellar infratentorial, posterior transfalcine interhemispheric, and occipital transtentorial approaches were employed. <b>Results</b> Among 35 patients, 17 had hydrocephalus and required ventricular drainage to address third ventricle obstruction. Complete tumor resection was achieved in 55% of patients. The mortality rate was 13.7% in the open surgical group and 15.625% in the endoscopic third ventriculostomy (ETV) group. <b>Conclusion</b> Proper patient positioning and selecting the optimal approach are crucial for a successful outcome.