Hydrocephalus with pinealoma often necessitates urgent shunting - ventriculo-peritoneal usually, or ventriculo-atrial. Bilateral shunts may be required with large tumours which extend anteriorly and risk obstructing the foramen of Munro.
Surgery is difficult because of the site of the tumour. The majority are treated without histological determination, by radiotherapy. About 70% are radiosensitive and respond rapidly.
Direct operative exploration or stereotactic biopsy is indicated when the tumour fails to respond to radiotherapy.
Mean survival for patients who have received shunts followed by radiotherapy is 4-5 years.
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