History and Advances of Surgical Approaches to Pineal Region Tumors

Introduction: While Descartes characterized the pineal gland as the "seat of the soul" in 1649, it was not until the 1900s that meaningful surgical interventions were pioneered. Here we discuss the evolution of surgery for pineal region tumors, often considered one of the most challenging neurosurgical operations due to the deep operative corridor and adjacent critical neurovascular structures.

Methods: A thorough literature review was conducted on articles and foundational texts over the last hundred years in PubMed and archives such as JSTOR. Each article was rigorously assessed for its relevance, quality, and historical significance to the evolution of pineal tumor resection techniques.

Results: The inception of surgical interventions for pineal region tumors began with the foundational work of Horsley, Oppenheim, and Krause in the 1910s. The following decades witnessed the introduction of innovative approaches, including Dandy’s posterior transcallosal approach, Krause’s infratentorial supracerebellar technique, and Van Wagenen’s transcortical transventricular method, collectively contributing to significant reductions in mortality and morbidity of operative resection of these deep-seated tumors. The progress continued into the 1970-80s with refinements from Stein, Jamieson, Yasargil, and the advent of Brunner’s occipital transtentorial approach. The 21st century saw the incorporation of robotics, endoscopy, and AI, enhancing precision and offering new insights, while challenges such as cerebellar tissue retraction continue to be addressed. Today, we prioritize the development and refinement of minimally invasive techniques, integration of real-time imaging, and personalized surgical strategies to further improve patient outcomes and address existing challenges.

Conclusion : The progression from Descartes' philosophical reflections to use of advanced technologies in the surgery of pineal region tumors illustrates a common trajectory in neurosurgical history: Improvement of basic techniques and surgical adjuncts to improve patient mortality in the early 1900s with a progression to technical advancements limiting morbidity and the neurosurgical footprint in the modern era.