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Purpose: To analyze neuro-ophthalmology symptoms in patients with germinomas located in pineal and suprasellar regions., Material and Methods: The study analyzed 133 patients with germinoma who were receiving treatment in Burdenko Neuro-surgical Institute from 2008 to 2017. Assessment of results was performed by neuro-ophthalmology examination, a computerized oculograph was used for the objectification of the severity of ocular-motor and pupillary disorders., Results: Among the patients of the study, 65 had pineal germinoma, 42 - suprasellar germinoma and 26 - bifocal germinoma. Among patients with pineal germinomas, males prevailed, while more females had suprasellar germinomas. No statistical difference was found between gender and bifocal germinoma. Pineal germinomas were manifested predominantly by the development of the dorsal midbrain syndrome in the form of oculomotor and pupillary dysfunction (75%) and the development of papilledema (53%). Germinomas of suprasellar localization are most often presented by asymmetric chiasmatic syndrome (24%). Dorsal midbrain syndrome in patients with bifocal germinomas was detected in 76% cases, combination of oculomotor and pupillary dysfunction with visual impairments was found in 38% cases. Neuro-ophthalmological symptoms of germinoma of these regions manifest in the early stages of the disease and require ophthalmological examination during all stages of diagnosis and treatment.

Primary pineal melanocytomas are extremely rare pathologies and predominantly are clinically manifested by nonspecific symptoms of a pineal affect, which could be characteristic for tumors of different histological nature located in the same region. Also these tumors differ from other melanocytic tumors by their slow growth and relatively favorable clinical prognosis.

The most common clinical manifestations of space-occupying lesions of the midbrain and pineal region are oculomotor and pupil disorders and ophthalmoscopic signs of intracranial hypertension., Purpose: To identify patterns of neuro-ophthalmic symptoms before and after surgical treatment in patients with space-occupying lesions of the midbrain and pineal region., Material and Methods: We analyzed neurological symptoms in 231 patients with space-occupying lesions of the midbrain and pineal region before and after surgical treatment. Malignant tumors were detected in 121 patients; benign tumors were present in 73 patients; 37 patients were diagnosed with pineal gland cysts. Patients with suspicion of germinoma underwent a tumor biopsy only; the other patients underwent tumor resection., Results and Discussion: Before surgery, oculomotor and pupil disorders were detected in more than half of the (67%) patients; ophthalmoscopic signs of intracranial hypertension were present in 38% of the patients. Neuro-ophthalmic symptoms significantly more often occurred in patients with malignant tumors. Midbrain symptoms were significantly more pronounced in germ cell tumors than in other malignant neoplasms. In the early postoperative period after tumor resection, deterioration of oculomotor and pupillary functions occurred in 46% of cases; there were no changes in 51% of cases; improvement occurred in 3% of cases. After tumor biopsy, symptoms in all patients with germinomas remained at the preoperative level. Developed symptoms partially regressed in the long-term period, and finally, only 29% of patients had deterioration of oculomotor and pupillary functions compared to the preoperative level.

A pineal cyst (PC) is a benign neoplasm in the pineal region, or more precisely in the pineal body. Most cysts are incidental findings and are not associated with symptoms typical of patients seeking medical advice. Symptomatic cysts are discovered less often and, depending on the clinical picture, require different treatment approaches., Material and Methods: We analyzed the literature data about the clinical picture, diagnosis, and treatment of PCs for more than a century (1914-2016)., Conclusion: To date, there is no single approach for managing PC patients. The indications for surgical treatment of symptomatic PCs are still not fully defined. It remains unclear which PC cases should be followed-up, and how often control examinations should be performed. More research of PCs is needed to develop new approaches to treatment of PC patients.