Clinico-radiological Analysis and outcomes of management of pineal region space occupying lesions: A multi-departmental, retrospective case series from Pakistan.

Background and objective: Pineal region tumors are rare intracranial lesions accounting for less than one percent, with heterogeneous histopathology. This study aimed to provide a comprehensive overview of pineal region lesions, their clinical and radiological presentation, and their management and outcomes. Methodology: This was a retrospective case series conducted at the Departments of Punjab Institute of Neurosciences. The study included all patients who underwent surgical excision or supportive procedures (cerebrospinal fluid [CSF] diversion and biopsy) for pineal region space-occupying lesions (SOLs) between January 1, 2022, and December 31, 2024. A non-probability consecutive sampling technique was used to enroll all the patients who fitted inclusion criteria, during the defined study period. A total of 32 patients were included in the final analysis. Results: A total of 32 patients were reviewed, 68.8% (22) males and 31.3%(10) females with a mean age of 24.1±12.3 years. The most common presentation was headache in 87.5% (28). Radiologically, the lesion was hypodense in 81.3% (26) on computed tomography (CT). On magnetic resonance imaging (MRI), 34.4% (11) were hypointense on the T1 weighted images and 90.6% (29) were hyperintense on the T2 weighted images, and 53.1%(17) was homogenously enhanced on contrast. Among all, 40.6% (13) had surgical excision,46.9% (15) had only biopsy, and 6.3%(2) underwent cerebrospinal fluid (CSF) diversion surgery. On histopathology, 21.9% (7) were pineocytoma, 21.9% (7) were germinomas,12.5% (4) were pineoblastomas. Post-operative weakness occurred in 6.2% (2) and cerebrospinal fluid (CSF) leak occurred in 3.1%(1) patients. Conclusion: This study reinforces the clinical and surgical complexity of managing pineal region tumors, which present with symptoms of increased intracranial pressure. Continued integration of minimally invasive techniques, neuronavigation, and multidisciplinary care is essential for optimizing outcomes in this diverse tumor group.