Pineal Tumors

Pineal Tumors

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The pineal gland develops during the second month of gestation as a diverticulum in the diencephalic roof of the third ventricle. It is flanked by the posterior and habenular commissures in the rostral portion of the midbrain directly below the splenium of the corpus callosum. The velum interpositum is found rostral and dorsal to the pineal gland and contains the internal cerebral veins, which join to form the vein of Galen.

In their 1954 pineal tumor study, Ringertz and colleagues defined the pineal region as being bound by the splenium of the corpus callosum and tela choroidea dorsally, the quadrigeminal plate and midbrain tectum ventrally, the posterior aspect of the third ventricle rostrally, and the cerebellar vermis caudally. [1] Important anatomic considerations include the presence of deep venous structures.

The pineal gland is richly innervated with sympathetic noradrenergic input from a pathway that originates in the retina and courses through the suprachiasmatic nucleus of the hypothalamus and the superior cervical ganglion. Upon stimulation, the pineal gland converts the sympathetic input into hormonal output by producing melatonin, which has regulatory effects upon hormones such as luteinizing hormone and follicle-stimulating hormone.

The pineal gland is a neuroendocrine transducer that synchronizes hormonal release with phases of the light-dark cycle by means of its sympathetic input. However, the exact relationship between the pineal gland and human circadian rhythm remains unclear and is an active area of investigation.

Pineal region tumors are derived from cells located in and around the pineal gland. The principal cell of the pineal gland is the pineal parenchymal cell or pinocyte. This cell is a specialized neuron related to retinal rods and cones. The pinocyte is surrounded by a stroma of fibrillary astrocytes, which interact with adjoining blood vessels to form part of the blood-pial barrier.

The pathophysiology of pineal region tumors is mostly a result of anatomic compression of adjacent structures, although local infiltration of neural structures can lead to symptoms in cases of highly invasive tumors. In some cases, neuroendocrine dysfunction is precipitated by specific factors secreted by the tumor. [2, 3]

Tumors of the pineal region have a varied histology that generally can be divided into germ cell and non–germ cell derivatives. Most tumors are a result of displaced embryonic tissue, malignant transformation of pineal parenchymal cells, or transformation of surrounding astroglia. [4, 5] No specific genetic mutations have been associated with sporadic pineal region tumors.

Some images of pineal tumors are provided below.

Indications for neurosurgical intervention relate to the severity and chronicity of clinical presentation. The symptoms of pineal region tumors can be as varied as their diverse histology. Prodromal periods can last from weeks to years. Therefore, a rigorous and uniform preoperative workup is a requisite for all patients thought to harbor a pineal region tumor.

Any endocrine abnormalities should be investigated prior to surgery. Patients presenting with signs and symptoms of raised intracranial pressure must receive a head CT scan or an MRI to assess the need for emergent management. Subsequent nonemergent workup of a patient with a pineal region tumor can be divided into radiologic and laboratory studies. [6, 7, 8]

Initial management of patients with pineal region tumors should be directed at treating hydrocephalus and establishing a diagnosis. Preoperative evaluation should include (1) high-resolution MRI of the head with gadolinium; (2) measurement of serum and CSF markers, if available; (3) cytologic examination of CSF, if available; (4) evaluation of pituitary function if endocrine abnormalities are suspected; and (5) visual field examination if suprasellar extension of the tumor is noted on MRI. The ultimate management goal should be to refine adjuvant therapy based on tumor pathology. [6, 7, 8]

Relatively few contraindications specifically preclude the surgical treatment of pineal region tumors. Medical clearance for general anesthesia is a requisite, as well as preoperative evaluation of neck motion (ie, tolerance of flexion) prior to planning a supracerebellar/infratentorial approach.

Treatment includes radiation, chemotherapy, and surgery. [9, 10, 11, 12, 13]

In the early part of the 20th century, pineal region surgery had poor outcomes, with operative mortality approaching 90%. From Horsley’s initial attempt at removing a pineal mass in 1910 through the development of the lateral transventricular approach in 1931 by Van Wagenan, primitive anesthetic technique and the lack of an operating microscope hindered pineal region surgery. [14]

In 1948, Torkildsen argued for abandoning aggressive surgical resection in favor of cerebrospinal fluid (CSF) diversion followed by empiric radiotherapy. [15] If the patient did not respond to radiation, a surgical procedure to remove radioresistant tumor was performed. The algorithm of CSF diversion, radiation, and observation sometimes was successful; however, patients with benign lesions were exposed to unnecessary and ineffective radiation.

Modification of this treatment strategy led to the radiation test heralded by Japanese clinicians whose patient population had an inordinately high percentage of radiosensitive germinomas. According to this protocol, patients were administered small doses of radiation, and their cases were followed radiologically. Pineal tumors that decreased in size were presumed to be radiosensitive, and a full course of radiation was instituted. Patients not responding to radiotherapy underwent surgical exploration. Despite the low dose of radiation initially used, significant long-term morbidity remained associated with this strategy, particularly in children.

The advent of microsurgical techniques and stereotactic procedures in the later part of the 20th century has obviated the need for empiric radiotherapy without tissue diagnosis. Therapeutic decision-making now is based on tumor histology rather than radiation responsiveness. Currently, initial surgical management for tissue diagnosis, and possible resection, is the standard of care for most children with pineal region tumors. [16]

Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults and 3-8% of brain tumors in children. Most children are aged 10-20 years at presentation, with the average age at presentation being 13 years. Adults typically are older than 30 years at presentation. A complete differential diagnosis for masses in the pineal region also should include vascular anomalies, as well as metastatic tumor.

In a study of 35 consecutive patients from 7 academic centers of the Rare Cancer Network diagnosed between 1988 and 2006 (median age, 36 yr), median disease-free survival was 82 months. Age younger than 36 years was an unfavorable prognostic factor, and patients with metastases at diagnosis had poorer survival. Histologic subtypes were pineoblastoma in 21 patients, pineocytoma in 8 patients, and pineocytoma with intermediate differentiation in 6 patients. [17]

In a study of medical records of 31 patients with pineoblastoma (female, 67.7%; median age, 18.2 yr), median overall survival was found to be 8.7 years, with 2-, 5-, and 10- year actuarial rates of 89.5%, 69.4%, and 48.6%, respectively. Median disease-free survival was 10 years, with 2-, 5-, and 10- year actuarial rates of 84.3%, 62.6%, and 55.7%. [18]

In another study of patients with pineoblastoma, the overall survival rate was 54% (175 of 299 patients) at a mean follow-up of 31 ± 1.9 mo (range, 1-159 mo). A markedly worse prognosis was demonstrated for children aged 5 years or younger compared with older patients (5-year survival rate: 15% for children aged ≤5 yr vs 57% for children aged ≥5 yr). A failure to achieve gross total resection markedly worsened patient survival. [19]

Ringertz N, Nordenstam H, Flyger G. Tumors of the pineal region. J Neuropathol Exp Neurol. 1954 Oct. 13(4):540-61. [Medline].

Yelamanchi SD, Kumar M, Madugundu AK, Gopalakrishnan L, Dey G, Chavan S, et al. Characterization of human pineal gland proteome. Mol Biosyst. 2016 Nov 15. 12 (12):3622-3632. [Medline].

Sapède D, Cau E. The pineal gland from development to function. Curr Top Dev Biol. 2013. 106:171-215. [Medline].

Chatterjee D, Lath K, Singla N, Kumar N, Radotra BD. Pathologic Prognostic Factors of Pineal Parenchymal Tumor of Intermediate Differentiation. Appl Immunohistochem Mol Morphol. 2017 Aug 9. [Medline].

Yu T, Sun X, Wang J, Ren X, Lin N, Lin S. Twenty-seven cases of pineal parenchymal tumours of intermediate differentiation: mitotic count, Ki-67 labelling index and extent of resection predict prognosis. J Neurol Neurosurg Psychiatry. 2016 Apr. 87 (4):386-95. [Medline].

Fang AS, Meyers SP. Magnetic resonance imaging of pineal region tumours. Insights Imaging. 2013 Jun. 4 (3):369-82. [Medline].

Awa R, Campos F, Arita K, Sugiyama K, Tominaga A, Kurisu K, et al. Neuroimaging diagnosis of pineal region tumors-quest for pathognomonic finding of germinoma. Neuroradiology. 2014 Jul. 56 (7):525-34. [Medline].

Kakigi T, Okada T, Kanagaki M, Yamamoto A, Fushimi Y, Sakamoto R, et al. Quantitative imaging values of CT, MR, and FDG-PET to differentiate pineal parenchymal tumors and germinomas: are they useful?. Neuroradiology. 2014 Apr. 56 (4):297-303. [Medline].

Azab WA, Nasim K, Salaheddin W. An overview of the current surgical options for pineal region tumors. Surg Neurol Int. 2014. 5:39. [Medline].

Balossier A, Blond S, Reyns N. Endoscopic Versus Stereotactic Procedure for Pineal Tumor Biopsies: Focus on Overall Efficacy Rate. World Neurosurg. 2016 Aug. 92:223-8. [Medline].

Edson MA, Fuller GN, Allen PK, Levine NB, Ghia AJ, Mahajan A, et al. Outcomes After Surgery and Radiotherapy for Papillary Tumor of the Pineal Region. World Neurosurg. 2015 Jul. 84 (1):76-81. [Medline].

Balossier A, Blond S, Touzet G, Lefranc M, de Saint-Denis T, Maurage CA, et al. Endoscopic versus stereotactic procedure for pineal tumour biopsies: Comparative review of the literature and learning from a 25-year experience. Neurochirurgie. 2015 Apr-Jun. 61 (2-3):146-54. [Medline].

Fauchon F, Hasselblatt M, Jouvet A, Champier J, Popovic M, Kirollos R, et al. Role of surgery, radiotherapy and chemotherapy in papillary tumors of the pineal region: a multicenter study. J Neurooncol. 2013 Apr. 112 (2):223-31. [Medline].

Van Wagenen WP. A surgical approach for removal of certain pineal tumors: Report of a case. Surg Gynecol Obstet. 1931. 53:216.

Torkildsen A. Should extirpation be attempted in cases of neoplasms in or near the third ventricle of the brain? Experiences with a palliative method. Journal of Neurosurgery. 1948. 5:269.

Iorio-Morin C, Kano H, Huang M, Lunsford LD, Simonová G, Liscak R, et al. Histology-Stratified Tumor Control and Patient Survival After Stereotactic Radiosurgery for Pineal Region Tumors: A Report From the International Gamma Knife Research Foundation. World Neurosurg. 2017 Jul 24. [Medline].

Villà S, Miller RC, Krengli M, Abusaris H, Baumert BG, Servagi-Vernat S, et al. Primary pineal tumors: outcome and prognostic factors–a study from the Rare Cancer Network (RCN). Clin Transl Oncol. 2012 Nov. 14 (11):827-34. [Medline].

Farnia B, Allen PK, Brown PD, Khatua S, Levine NB, Li J, et al. Clinical outcomes and patterns of failure in pineoblastoma: a 30-year, single-institution retrospective review. World Neurosurg. 2014 Dec. 82 (6):1232-41. [Medline].

Tate M, Sughrue ME, Rutkowski MJ, Kane AJ, Aranda D, McClinton L, et al. The long-term postsurgical prognosis of patients with pineoblastoma. Cancer. 2012 Jan 1. 118 (1):173-9. [Medline].

Choudhri AF, Whitehead MT, Siddiqui A, Klimo P Jr, Boop FA. Diffusion characteristics of pediatric pineal tumors. Neuroradiol J. 2015 Apr. 28 (2):209-16. [Medline].

Wu CC, Guo WY, Chang FC, Luo CB, Lee HJ, Chen YW, et al. MRI features of pediatric intracranial germ cell tumor subtypes. J Neurooncol. 2017 Aug. 134 (1):221-230. [Medline].

Al-Holou WN, Terman SW, Kilburg C, Garton HJ, Muraszko KM, Chandler WF, et al. Prevalence and natural history of pineal cysts in adults. J Neurosurg. 2011 Dec. 115(6):1106-14. [Medline].

Inoue A, Ohnishi T, Kohno S, Ohue S, Iwata S, Matsumoto S, et al. Identification of characteristic features of pineal germinoma that enhance accuracy of preoperative differentiation in pineal region tumors: its significance on optimum surgical treatment. Neurosurg Rev. 2017 Mar 1. [Medline].

Russell DS, Rubinstein LJ. Tumours and tumour-like lesions of maldevelopmental origin. Russel DS, Rubenstein LJ, eds. Pathology of tumours of the nervous sys. Baltimore, Md: Williams & Wilkins; 1989. 664-765.

Ashley DM, Longee D, Tien R, et al. Treatment of patients with pineoblastoma with high dose cyclophosphamide. Med Pediatr Oncol. 1996 Jun. 26(6):387-92. [Medline].

Fuller BG, Kapp DS, Cox R. Radiation therapy of pineal region tumors: 25 new cases and a review of 208 previously reported cases. Int J Radiat Oncol Biol Phys. 1994 Jan 1. 28(1):229-45. [Medline].

Manera L, Regis J, Chinot O, et al. Pineal region tumors: the role of stereotactic radiosurgery. Stereotact Funct Neurosurg. 1996. 66 Suppl 1:164-73. [Medline].

Regis J, Bouillot P, Rouby-Volot F, et al. Pineal region tumors and the role of stereotactic biopsy: review of the mortality, morbidity, and diagnostic rates in 370 cases. Neurosurgery. 1996 Nov. 39(5):907-12; discussion 912-4. [Medline].

Kreth FW, Schätz CR, Pagenstecher A, et al. Stereotactic management of lesions of the pineal region. Neurosurgery. 1996 Aug. 39(2):280-9; discussion 289-91. [Medline].

Ferrer E, Santamarta D, Garcia-Fructuoso G, et al. Neuroendoscopic management of pineal region tumours. Acta Neurochir (Wien). 1997. 139(1):12-20; discussion 20-1. [Medline].

Pople IK, Athanasiou TC, Sandeman DR, Coakham HB. The role of endoscopic biopsy and third ventriculostomy in the management of pineal region tumours. Br J Neurosurg. 2001 Aug. 15(4):305-11. [Medline].

Gangemi M, Maiuri F, Colella G, Buonamassa S. Endoscopic surgery for pineal region tumors. Minim Invasive Neurosurg. 2001 Jun. 44(2):70-3. [Medline].

Oi S, Kamio M, Joki T, Abe T. Neuroendoscopic anatomy and surgery in pineal region tumors: role of neuroendoscopic procedure in the ‘minimally-invasive preferential’ management. J Neurooncol. 2001 Sep. 54(3):277-86. [Medline].

Takeda J, Nonaka M, Li Y, Komori Y, Kamei T, Iwata R, et al. 5-ALA fluorescence-guided endoscopic surgery for mixed germ cell tumors. J Neurooncol. 2017 Aug. 134 (1):119-124. [Medline].

Choi JU, Kim DS, Chung SS, et al. Treatment of germ cell tumors in the pineal region. Childs Nerv Syst. 1998 Jan-Feb. 14(1-2):41-8. [Medline].

Sawamura Y, de Tribolet N, Ishii N, et al. Management of primary intracranial germinomas: diagnostic surgery or radical resection?. J Neurosurg. 1997 Aug. 87(2):262-6. [Medline].

Dandy WE. Operative experience in cases of pineal tumor. Archives of Surgery. 1936. 33:19-46.

Patel PG, Cohen-Gadol AA, Mercier P, Boop FA, Klimo P Jr. The Posterior Transcallosal Approach to the Pineal Region and Posterior Third Ventricle: Intervenous and Paravenous Variants. Oper Neurosurg (Hagerstown). 2017 Feb 1. 13 (1):77-88. [Medline].

Stein BM, Bruce JN. Surgical management of pineal region tumors (honored guest lecture). Clin Neurosurg. 1992. 39:509-32. [Medline].

Oliveira J, Cerejo A, Silva PS, Polónia P, Pereira J, Vaz R. The infratentorial supracerebellar approach in surgery of lesions of the pineal region. Surg Neurol Int. 2013. 4:154. [Medline].

Abecassis IJ, Hanak B, Barber J, Mortazavi M, Ellenbogen RG. A Single-Institution Experience with Pineal Region Tumors: 50 Tumors Over 1 Decade. Oper Neurosurg (Hagerstown). 2017 Oct 1. 13 (5):566-575. [Medline].

Anan M, Ishii K, Nakamura T, Yamashita M, Katayama S, Sainoo M, et al. Postoperative adjuvant treatment for pineal parenchymal tumour of intermediate differentiation. J Clin Neurosci. 2006 Nov. 13(9):965-8. [Medline].

Aoyama H. Radiation therapy for intracranial germ cell tumors. Prog Neurol Surg. 2009. 23:96-105. [Medline].

Borit A. History of tumors of the pineal region. Am J Surg Pathol. 1981 Sep. 5(6):613-20. [Medline].

Bruce DA, Allen JC. Tumor staging for pineal region tumors of childhood. Cancer. 1985 Oct 1. 56(7 Suppl):1792-4. [Medline].

Bruce J, Stein B. Supracerebellar approaches in the pineal region. Apuzzo M, ed. Brain Surgery: Complication Avoidance and Management. New York, NY: Churchill Livingstone; 1993. 511-536.

Bruce JN, Ogden AT. Surgical strategies for treating patients with pineal region tumors. J Neurooncol. 2004 Aug-Sep. 69(1-3):221-36. [Medline].

Bruce JN, Stein BM. Surgical management of pineal region tumors. Acta Neurochir (Wien). 1995. 134(3-4):130-5. [Medline].

Calaminus G, Bamberg M, Baranzelli MC, et al. Intracranial germ cell tumors: a comprehensive update of the European data. Neuropediatrics. 1994 Feb. 25(1):26-32. [Medline].

Calaminus G, Bamberg M, Jürgens H, Kortmann RD, Sörensen N, Wiestler OD, et al. Impact of surgery, chemotherapy and irradiation on long term outcome of intracranial malignant non-germinomatous germ cell tumors: results of the German Cooperative Trial MAKEI 89. Klin Padiatr. 2004 May-Jun. 216(3):141-9. [Medline].

Chernov MF, Kamikawa S, Yamane F, Ishihara S, Kubo O, Hori T. Neurofiberscopic biopsy of tumors of the pineal region and posterior third ventricle: indications, technique, complications, and results. Neurosurgery. 2006 Aug. 59(2):267-77; discussion 267-77. [Medline].

Cuccia V, Rodríguez F, Palma F, et al. Pinealoblastomas in children. Childs Nerv Syst. 2006 Jun. 22(6):577-85. [Medline].

Deshmukh VR, Smith KA, Rekate HL, Coons S, Spetzler RF. Diagnosis and management of pineocytomas. Neurosurgery. 2004 Aug. 55(2):349-55; discussion 355-7. [Medline].

Edwards MS, Hudgins RJ, Wilson CB, et al. Pineal region tumors in children. J Neurosurg. 1988 May. 68(5):689-97. [Medline].

Erlich SS, Apuzzo ML. The pineal gland: anatomy, physiology, and clinical significance. J Neurosurg. 1985 Sep. 63(3):321-41. [Medline].

Fèvre-Montange M, Champier J, Szathmari A, Wierinckx A, Mottolese C, Guyotat J, et al. Microarray analysis reveals differential gene expression patterns in tumors of the pineal region. J Neuropathol Exp Neurol. 2006 Jul. 65(7):675-84. [Medline].

Fèvre-Montange M, Hasselblatt M, Figarella-Branger D, Chauveinc L, Champier J, Saint-Pierre G, et al. Prognosis and histopathologic features in papillary tumors of the pineal region: a retrospective multicenter study of 31 cases. J Neuropathol Exp Neurol. 2006 Oct. 65(10):1004-11. [Medline].

Gururangan S, McLaughlin C, Quinn J, Rich J, Reardon D, Halperin EC, et al. High-dose chemotherapy with autologous stem-cell rescue in children and adults with newly diagnosed pineoblastomas. J Clin Oncol. 2003 Jun 1. 21(11):2187-91. [Medline].

Inoue HK, Naganuma H, Ono N. Pathobiology of intracranial germ-cell tumors: immunochemical, immunohistochemical, and electron microscopic investigations. J Neurooncol. 1987. 5(2):105-15. [Medline].

Jakacki RI, Zeltzer PM, Boyett JM, et al. Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: a report of the Childrens Cancer Group. J Clin Oncol. 1995 Jun. 13(6):1377-83. [Medline].

Konovalov AN, Pitskhelauri DI. Principles of treatment of the pineal region tumors. Surg Neurol. 2003 Apr. 59(4):250-68. [Medline].

Krabbe KH. The pineal gland, especially in relation to the problem on its supposed significance in sexual development. Endocrinology. 1923. 7:379-414.

Matsutani M. Pineal germ cell tumors. Prog Neurol Surg. 2009. 23:76-85. [Medline].

Parwani AV, Baisden BL, Erozan YS, et al. Pineal gland lesions: a cytopathologic study of 20 specimens. Cancer. 2005 Apr 25. 105(2):80-6. [Medline].

Posner M, Horrax G. Eye signs in pineal tumors. Journal of Neurosurgery. 1946. 3:15-24.

Quest DO, Kleriga E. Microsurgical anatomy of the pineal region. Neurosurgery. 1980 Apr. 6(4):385-90. [Medline].

Radovanovic I, Dizdarevic K, de Tribolet N, Masic T, Muminagic S. Pineal region tumors–neurosurgical review. Med Arh. 2009. 63(3):171-3. [Medline].

Sato K, Takeuchi H, Kubota T. Pathology of intracranial germ cell tumors. Prog Neurol Surg. 2009. 23:59-75. [Medline].

Silvani A, Eoli M, Salmaggi A, Lamperti E, Fariselli L, Milanesi I, et al. Combined chemotherapy and radiotherapy for intracranial germinomas in adult patients: a single-institution study. J Neurooncol. 2005 Feb. 71(3):271-6. [Medline].

Smirniotopoulos JG, Rushing EJ, Mena H. Pineal region masses: differential diagnosis. Radiographics. 1992 May. 12(3):577-96. [Medline].

Villano JL, Propp JM, Porter KR, Stewart AK, Valyi-Nagy T, Li X, et al. Malignant pineal germ-cell tumors: an analysis of cases from three tumor registries. Neuro Oncol. 2008 Apr. 10(2):121-30. [Medline]. [Full Text].

Yamini B, Refai D, Rubin CM, Frim DM. Initial endoscopic management of pineal region tumors and associated hydrocephalus: clinical series and literature review. J Neurosurg. 2004 May. 100(5 Suppl Pediatrics):437-41. [Medline].

Jeffrey N Bruce, MD Edgar M Housepian Professor of Neurological Surgery Research, Vice-Chairman and Professor of Neurological Surgery, Director of Brain Tumor Tissue Bank, Director of Bartoli Brain Tumor Laboratory, Department of Neurosurgery, Columbia University College of Physicians and Surgeons

Jeffrey N Bruce, MD is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American Association of Neurological Surgeons, American Society of Clinical Oncology, Congress of Neurological Surgeons, New York Academy of Sciences, North American Skull Base Society, Pituitary Society, Society for Neuro-Oncology, Society of Neurological Surgeons

Disclosure: Received grant/research funds from NIH for other.

Benjamin Kennedy, MD Columbia University College of Physicians and Surgeons

Disclosure: Nothing to disclose.

Alfred T Ogden, MD Assistant Professor, Department of Neurological Surgery, Columbia University Medical Center

Alfred T Ogden, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Richard CE Anderson, MD Assistant Professor of Neurosurgery and Pediatric Neurosurgery, Columbia University Medical Center, Columbia University College of Physicians and Surgeons; Director, Pediatric Neurosurgery, St Joseph’s Children’s Hospital

Richard CE Anderson, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, Congress of Neurological Surgeons, American Association of Neurological Surgeons, Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Brian H Kopell, MD Associate Professor, Department of Neurosurgery, Icahn School of Medicine at Mount Sinai

Brian H Kopell, MD is a member of the following medical societies: Alpha Omega Alpha, American Association of Neurological Surgeons, American Society for Stereotactic and Functional Neurosurgery, Congress of Neurological Surgeons, International Parkinson and Movement Disorder Society, North American Neuromodulation Society

Disclosure: Received consulting fee from Medtronic for consulting; Received consulting fee from Abbott Neuromodulation for consulting.

Michael G Nosko, MD, PhD Associate Professor of Surgery, Chief, Division of Neurosurgery, Medical Director, Neuroscience Unit, Medical Director, Neurosurgical Intensive Care Unit, Director, Neurovascular Surgery, Rutgers Robert Wood Johnson Medical School

Michael G Nosko, MD, PhD is a member of the following medical societies: Academy of Medicine of New Jersey, Congress of Neurological Surgeons, Canadian Neurological Sciences Federation, Alpha Omega Alpha, American Association of Neurological Surgeons, American College of Surgeons, American Heart Association, American Medical Association, New York Academy of Sciences, Society of Critical Care Medicine

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Andrew T Parsa, MD, PhD, and Chris E Mandigo, MD.

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