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A Case of Pineal Region Germinoma Treated by Interstitial Brachytherapy Hisato HIGASHI 1 , Kengo MATSUMOTO 1 , Hisashi ADACHI 1 , Susumu TOMITA 1 , Tomohisa FURUTA 1 , Takashi OHMOTO 1 1Department of Neurological Surgery, Okayama University Medical School Keyword: Germinoma , Irradiation , MRI-guided stereotactic biopsy , Brachytherapy pp.683-687
Published Date 1994/7/10
DOI https://doi.org/10.11477/mf.1436900878
  • Abstract
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Although radiation therapy has been universally accepted as treatment for primary intracranial germino-mas, the optimal technique for both diagnosis and treat-ment continues to be a matter of controversy. We re-port a case of germinoma in the pineal region treated by interstitial brachytherapy. A 23-year-old female was admitted with diplopia and consciousness disturbance.Magnetic resonance imagings (MRI) revealed an en-hanced tumor of the pineal region and hydrocephalus. No serum and CSF tumor markers such as alpha-fetoprotein (AFP), human chorionic gonadotropin (HCG) or placental alkaline phosphatase (PLAP) were detectable. Stereotactic needle biopsy was performed using BRW MRI-guided stereotactic apparatus. After the histological diagnosis confirmed the presence of germinoma, three catheters for interstitial brachyther-apy were implanted into the tumor through the biopsy tract, and iridium-192 seeds were inserted into the catheters and kept there for 5 days to give 35 Gy of irradiation at the tumor periphery. Subsequent MRI showed marked tumor regression and the clinical symp-toms were gradually improved, and Gd-enhanced tumor on MRI completely disappeared 2 months after brachytherapy.

Histological diagnosis is essential before initiation of treatment because a germinoma is commonly thought to be radiosensitive. However, pineal region tumor is dangerous to remove surgically because of high mor-bidity and mortality rates. Image-guided stereotactic technique provides a safe method to obtain an accurate diagnosis, and subsequent interstitial brachytherapy en-ables selective irradiation of the tumor, and does not give rise to complications caused by external irradiation such as mental disturbance, hypopituitarism, visual dis-turbance and brain necrosis. Interstitial brachytherapy following image-guided biospy can be a useful tool for Patients with germinoma.


Copyright © 1994, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1251 印刷版ISSN 0301-2603 医学書院

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