NCOG-08. Clinico-radiological analysis and outcomes of management of pineal region space occupying lesions: a multi-departmental, retrospective case series from Pakistan

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.