- Tumor location and extent
- Tumor size
- Patient age
Raised intracranial pressure is common.
- Often due to the compression of the Sylvian aqueduct by the tumor.
- Increased intracranial pressure causes:
- papilledema
- headache
- nausea and vomiting
- Can be treated by ventriculoperitoneal shunting (may have risk of dissemination with this) or third ventriculostomy.
Cerebellar signs
- Due to compression of efferent pathways or the cerebellar peduncles.
- Causes ataxia - Gait abnormalities, unsteadiness and frequent falls.
Eye signs
- Pineal gland is very close to the pretectum, eye symptoms are common.
- The pretectum, which includes the ocular motor centre and pupillary control centre, is between the thalamus and the midbrain. It is responsible for mediating vertical eye movements.
- Problems with the visual pathways in pineal tumors are listed in table below.
- Parinaud's Syndrome results in several different visual deficits which include:
- paralysis of upward gaze
- reduced pupillary reflexes to light
- convergence paresis
Endocrine deficits
- Associated with germinomas and hypothalamic lesions.
- The three main deficits associated with germinoma are:
- diabetes insipidus
- visual field defects
- hypothalamic dysfunction
- Most other neuroendocrine deficits are secondary deficits.
- These may include hypopituitarism, growth failure, and elevated hCG or LH level.
- It is far less common to have these secondary neuroendocrine deficits with non-germinoma germ cell tumors.
- Choriocarcinoma associated with sexual precocity. It may also be signaled by an increase in CSF concentrations of hCG and LH.
There are also several non-specific neurological deficits that can appear as a result of a pituitary tumor.
Intracranial hemorrhage is rare but a well-documented side effect of pineal tumors.
- Occurs in tumors of various histological subtypes as well as in non-neoplastic masses.
- The bleeding may cause pineal apoplexy or subarachnoid hemorrhage.
- Massive hemorrhage into choriocarcinomas and endodermal sinus tumors is most frequent.
- Tumors of the pineal parenchyma are also very vascular.
- Repeated subarachnoid hemorrhage is associated with germinomas and pineocytomas.
Non-germinoma germ cell tumors tend to have localized clinical features due to pineal mass effect.
Table : Summary of symptoms associated with pineal region tumors.
Increased intracranial pressure |
Papilledema Headaches Nausea Vomiting |
Cerebellar signs |
Gait abnormalities Frequent falls |
Ocular symptoms |
Accommodation deficiency Oculomotor nerve palsy Parinaud's Syndrome
Failure of downward gaze Visual field disturbance (mass effect post chiasm) Lid retraction (midbrain dysfunction) Pupillary abnormality |
Neuroendocrine dysfunction |
Precocious puberty Hypopituitarism Growth failure Increased hCG and LH levels Diabetes insipidus |
Non-specific neurologic deficits |
Diplopia Seizures Choreoathetosis Ophthalmoplegia Dementia Psychosis |
