SURG-102. Modified Poppen’s approach for pineal region lesions: Indications, technical nuances and outcomes

Abstract BACKGROUND Pineal region lesions are managed by various surgical options, including endoscopy, microsurgery and stereotactic biopsy. METHODS The details of all patients who underwent modified Poppen’s approach for pineal region lesions were retrieved from the department registry. The clinical details, surgical procedure details, post operative outcomes were tabulated from case records. Extent of resection was noted from the post-operative images. RESULTS Twenty three patients underwent modified Poppen’s approach in our Institute from 2016 till 2022. The age ranged from 9 – 69 years.. Eighteen patients had features of raised ICP at presentation. Eighteen patients had right sided approach and five had left sided approach. Gross / near total resection was possible in 10 patients(43.5%). Two patients developed hemiparesis post-operatively. Two patients developed worsening of upgaze restriction. One patient had left occipital hematoma causing difficulty in recognition of objects and color which gradually improved. One patient required VP shunt for hydrocephalus and another required thecoperitoneal shunt for pseudomeningocele. There was no operative mortality in this cohort. Histopathological examination revealed pineal parenchymal tumors were the most common (6/23), followed by meningioma (6/23), germ cell tumors (2/23), papillary tumor of pineal region (2/23), epidermoid (2/23). CONCLUSIONS Modified Poppen’s approach is a safe surgical approach for pineal region tumors which can result in near / gross total resection in 43.5% patients. Imaging features of non germ cell tumors and large tumors causing raised ICP can aid the surgeon in decision making for tumor decompression and plan further management.