Pineal region lesions pose a complex therapeutic challenge in which patient-related, as well as tumor-specific variables influence the optimal management paradigm. Advances in surgical techniques have minimized complications while facilitating extensive resection. Surgery for maximal resection of all benign and most malignant tumors can often be quite effective or even curative for select patients. Patients such as those with positive CSF or blood markers, or those with disseminated disease, will benefit from a different therapeutic strategy. The nuances of the decision-making algorithm for surgical treatment of pineal region lesions are discussed in this chapter. Special emphasis is made of the surgical results based on specific pathology, and the optimal patient selection for particular approaches.
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