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Pineal Region Lesions Management Strategies and Controversial Issues Ioan Stefan Florian Editor 123 Pineal Region Lesions Ioan Stefan Florian Editor Pineal Region Lesions Management Strategies and Controversial Issues Editor Ioan Stefan Florian Department of Neurosurgery Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca Romania ISBN 978-3-030-50912-5 ISBN 978-3-030-50913-2 (eBook) https://doi.org/10.1007/978-3-030-50913-2 © Springer Nature Switzerland AG 2020 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors, and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. This Springer imprint is published by the registered company Springer Nature Switzerland AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword If I dared to explore a remote, exotic location, I would certainly like to have a detailed map or an elaborate guide to disclose the many secrets and myster- ies of that land. The pineal region is such an exotic locale, an area that for eons has nourished the imaginations of thinkers and philosophers, from ancient to modern times alike. From the mythical “third eye,” to the “seat of the soul” of the post-Renaissance period, or from “unapproachable lesions” to the myriad options that current neurosurgical techniques offer, the pineal region and the gland nestled at its core have proven a fountain of inspiration for professionals of various fields of knowledge and experimentation. The book that you hold in hour hands was designed to be a well-documented guide, the authors of each chapter acting as a chaperon on this path cobbled by challenges and controversies, in a region whose pathology, albeit rare, is extremely diverse. It is precisely the underscoring of the controversial aspects within all of the chapters that represent a peculiarity of this volume, raising not only problematic questions but also answers borne out of the proficiency of their experienced authors, while even leaving the reader able to discern the best available solution in light of their understanding. Assembled logically and didactically, the scope of this book is a system- atization of the key features regarding the pathology of the pineal region. Considering that in the last few years, there has been a scarcity of books principally dedicated to the pathology of this area, and those mostly focused on the oncological aspect, the current tome encompasses almost the entire range of lesions encountered in the pineal region. Divided into seven parts, this volume takes the reader on a broad. Yet, a coherent journey is beginning with the history regarding specific interest for the pineal gland and its sur- roundings, as well as anatomical data with practical applicability. Pathological data is preceded by clinical aspects, the reader then being ushered toward imaging features, as well as the importance of biomarkers with an emphasis on oncological diseases. Naturally, a section dedicated to surgical approaches to the pineal region follows, as presented by eminent neurosurgical figures in their respective fields, offering not only detailed description of these approaches but also tips and tricks inherited from their experience. Moreover, the controversial aspects concerning these surgical routes are linked with an abundance of illustrative radiological studies, preoperative, intraoperative, and postoperative alike. Therapy for the majority of oncological lesions in this region is multi- modal. As such, specialists in this field present the available options in terms v vi Foreword of radiotherapy and chemotherapy according to the various tumor types encountered. Oncological therapy, the subject of the ensuing section, sets the stage for renowned neurosurgeons to share their knowledge concerning the common tumors encountered in this area, in combination with the current therapeutic options available, and illustrated with instructive personal cases. The part on vascular pathology embodies three separate chapters, namely cavernous malformations, the vein of Galen aneurysms, and arteriovenous malformations, respectively, as imparted by figures with an unanimously rec- ognized experience. The pineal region can also play as the site for cysts, whether simple or malformative, the aspects of these lesions being presented in a distinct section. Last but not least, the treatment algorithm that brings this volume to a close proffers a concise synthesis of current diagnostic means and manage- ment solutions presently available. I consider this book not only a beneficial foray in pineal region pathology, but even more so an opportunity to visit, and on occasion revisit from differ- ent perspectives, the diagnostic tools and therapeutic choices of a diverse set of ailments in a diminutive area. Even though the pineal gland and its sur- roundings sometimes display a frightening aura, this is effectively shattered by the remarkable effort of the authors, whom the editor had the distinct pleasure to unite in an ambitious scientific endeavor. I am sure that the editor of this book took a lot of effort to gather all this information and offer the reader a complete source. Beyond that, he inter- preted the information with years of experience, and he hid his real experi- ence between the lines of the book. For this reason, I strongly recommend this book not only to young colleagues who are interested in neurosurgery but also to colleagues with years of experience. In short, colleagues from all dis- ciplines dealing with pineal region lesions “trust the guidance of Professor Florian!” Ihsan Solaroglu Department of Neurosurgery School of Medicine, Koç University Istanbul, Turkey Preface A good book is one which keeps the reader enthralled and coming back for more; if it also opens up the pathway to previously untapped knowledge, and if it holds your hand during the most difficult steps, then that book becomes part of one’s soul. I hope that this, dear reader, will be the case for you as well since this volume is fostered not only by current and precise scientific data but also by the trials and endeavor of many talented neurosurgeons. Its pages are garnished with the fruit of several decades of experience, commitment, hopefulness, achieve- ments, and disappointments alike. Thus, each page from the tome you are hold- ing has its very own soul. Peruse it as an intimate dedication from a team of professionals who wish to impart onto you their beliefs as well as doubts attained from a vast personal experience. I remember being a first-year resident when I was presented with the opportunity to witness and discover the provocations posed by the pineal region alongside a coauthor of this very book. Ever since, I have never ceased in my pursuit of refining the surgical techniques involved in the approach of this perplexing area of the brain and the treatment of its ail- ments. For this reason, when the Springer Nature publishing house offered me the task of leading a project on this subject, I did not hesitate for a moment, even though such an assignment involves countless challenges. However, I had the opportunity of collaborating with exceptional figures in the neurosurgical soci- ety, personalities who not only epitomize the pillars of contemporary neurosur- gery but also whose kind support and friendship have honored me through the years. Alongside them, younger and very enthusiastic colleagues brought their own valuable contribution, demonstrating a keen understanding of such an opportunity for their professional development. I would like to address my warmest gratitude to all of my collaborators in this endeavor, with the added conviction that our combined effort managed to assemble a book that is compre- hensive and up-to-date, a bibliographical resource that we hope will prove useful to both current and future generations of neurosurgeons. I also offer Mrs. Ioana Robu, assistant editor, my sincerest appreciation for her decisive contribution in tying this project together. We collectively give thanks to the Springer Nature publishing house for their constant professional support that has honored us dur- ing the demanding course of this enterprise. And on behalf of all contributors to this book, I would like to thank you, dear reader, for choosing to peruse this book, which we genuinely wish will become a prized companion in your very own journey into the fascinating and mysterious world of the pineal region. Cluj-Napoca, Romania

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