{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T17:51:22Z","timestamp":1791222682228,"version":"4.1.0"},"reference-count":56,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"10","license":[{"start":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T00:00:00Z","timestamp":1757289600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,9,8]]},"abstract":"\n BACKGROUND<\/jats:title>\n High-grade astrocytoma with piloid features (HGAP) was recently added to the WHO 2021 CNS classification system among the group of circumscribed astrocytic gliomas. These tumors present with high-grade piloid histology with similarities to glioblastoma. HGAPs in the pineal region become particularly challenging due to its deep location and proximity to deep venous structures, the midbrain, and the thalamus. Herein, the authors present the case of a patient with an HGAP located in the pineal region. The tumor was resected using an exoscopic supracerebellar\/infratentorial approach.<\/jats:p>\n <\/jats:sec>\n \n OBSERVATIONS<\/jats:title>\n A 69-year-old man presented with a pineal gland mass causing obstructive hydrocephalus. Resection using an exoscope revealed an HGAP. Postoperatively, he developed posterior fossa syndrome but was discharged without neurological deficits after 30 days.<\/jats:p>\n <\/jats:sec>\n \n LESSONS<\/jats:title>\n HGAP, a distinct glioma subtype identified in 2021, presents a mix of low- and high-grade features. It shares histological traits with pilocytic astrocytoma and glioblastoma, requiring DNA methylation profiling for diagnosis. Radiologically, these lesions have a T2-FLAIR mismatch and uneven post-gadolinium enhancement. Treatment is still uncertain, although adjuvant chemoradiation therapy with temozolomide may be used. The prognosis is poor, with a 5-year survival rate of approximately 50%. For pineal region locations, the exoscope offers enhanced magnification, depth perception, and ergonomic benefits, improving surgical precision.<\/jats:p>\n \n https:\/\/thejns.org\/doi\/10.3171\/CASE25390<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/case25390","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T06:39:46Z","timestamp":1757313586000},"source":"Crossref","is-referenced-by-count":2,"title":["High-grade astrocytoma with piloid features resected with an exoscopic supracerebellar infratentorial approach: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"given":"Franco","family":"Rubino","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fleming Neuroscience Institute, Allentown, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, George Washington University School of Medicine & Health Science, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abir L.","family":"Mukherjee","sequence":"additional","affiliation":[{"name":"Department of Anatomic Pathology and Neuropathology, Lehigh Valley Health Network, Allentown, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6774-2066","authenticated-orcid":true,"given":"Walter C.","family":"Jean","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fleming Neuroscience Institute, Allentown, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Acta Neuropathol","first-page":"273","article-title":"Anaplastic astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A\/B and ATRX alterations","volume":"136","author":"Reinhardt","year":"2018","unstructured":"Reinhardt AStichel DSchrimpf DAnaplastic astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A\/B and ATRX alterations. Acta Neuropathol. 2018;136(2):273-291."},{"issue":"1","key":"bib2","series-title":"J Neurooncol","first-page":"109","article-title":"High-grade astrocytoma with piloid features (HGAP): the Charit\u00e9 experience with a new central nervous system tumor entity","volume":"153","author":"Bender","year":"2021","unstructured":"Bender KPerez EChirica MHigh-grade astrocytoma with piloid features (HGAP): the Charit\u00e9 experience with a new central nervous system tumor entity. J Neurooncol. 2021;153(1):109-120."},{"issue":"8","key":"bib3","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the central nervous system: a summary","volume":"23","author":"Louis","year":"2021","unstructured":"Louis DNPerry AWesseling PThe 2021 WHO Classification of Tumors of the central nervous system: a summary. Neuro Oncol. 2021;23(8):1231-1251."},{"issue":"4","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"367","article-title":"Newly recognized CNS tumors in the 2021 World Health Organization classification: imaging overview with histopathologic and genetic correlation","volume":"44","author":"Rigsby","year":"2023","unstructured":"Rigsby RKBrahmbhatt PDesai ABNewly recognized CNS tumors in the 2021 World Health Organization classification: imaging overview with histopathologic and genetic correlation. AJNR Am J Neuroradiol. 2023;44(4):367-380."},{"issue":"8","key":"bib5","series-title":"Neuro Oncol","first-page":"1474","article-title":"Clinical, histological, and molecular features of gliomas in adults with neurofibromatosis type 1","volume":"25","author":"Romo","year":"2023","unstructured":"Romo CGPiotrowski AFCampian JLClinical, histological, and molecular features of gliomas in adults with neurofibromatosis type 1. Neuro Oncol. 2023;25(8):1474-1486."},{"issue":"1","key":"bib6","series-title":"Acta Neuropathol","first-page":"71","article-title":"Expanded analysis of high-grade astrocytoma with piloid features identifies an epigenetically and clinically distinct subtype associated with neurofibromatosis type 1","volume":"145","author":"Cimino","year":"2023","unstructured":"Cimino PJKetchum CTurakulov RExpanded analysis of high-grade astrocytoma with piloid features identifies an epigenetically and clinically distinct subtype associated with neurofibromatosis type 1. Acta Neuropathol. 2023;145(1):71-82."},{"issue":"4","key":"bib7","series-title":"Cureus","first-page":"e58697","article-title":"Obstructive hydrocephalus due to aggressive posterior fossa tumor exhibiting histological characteristics of pilocytic astrocytoma in two adult neurofibromatosis type 1 (NF1) cases","volume":"16","author":"Nawa","year":"2024","unstructured":"Nawa SOhka FMotomura KObstructive hydrocephalus due to aggressive posterior fossa tumor exhibiting histological characteristics of pilocytic astrocytoma in two adult neurofibromatosis type 1 (NF1) cases. Cureus. 2024;16(4):e58697."},{"issue":"4","key":"bib8","series-title":"AJNR Am J Neuroradiol","first-page":"468","article-title":"High-grade astrocytoma with piloid features: a dual institutional review of imaging findings of a novel entity","volume":"45","author":"Soni","year":"2024","unstructured":"Soni NAgarwal AAjmera PHigh-grade astrocytoma with piloid features: a dual institutional review of imaging findings of a novel entity. AJNR Am J Neuroradiol. 2024;45(4):468-474."},{"issue":"1","key":"bib9","series-title":"Clin Neuroradiol","first-page":"279","article-title":"Freiburg Neuropathology Case Conference: 68-year-old patient with slurred speech, double vision, and increasing gait disturbance","volume":"34","author":"Zander","year":"2024","unstructured":"Zander CDiebold MShah MJFreiburg Neuropathology Case Conference: 68-year-old patient with slurred speech, double vision, and increasing gait disturbance. Clin Neuroradiol. 2024;34(1):279-286."},{"key":"bib10","series-title":"Arch Pathol Lab Med","article-title":"High-grade astrocytoma with piloid features","author":"Rudolf","year":"2025","unstructured":"Rudolf MAFerris SP.High-grade astrocytoma with piloid features. Arch Pathol Lab Med. 2025."},{"issue":"1","key":"bib11","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Feasibility of exoscopic keyhole surgery: case series","volume":"10","author":"S\u00e1ez-Alegre","year":"2024","unstructured":"S\u00e1ez-Alegre MR\u00edos-Vicil CPiper KNajera EJean WC.Feasibility of exoscopic keyhole surgery: case series. Neurosurg Focus Video. 2024;10(1):V3."},{"issue":"12","key":"bib12","series-title":"Acta Neurochir (Wien)","first-page":"4083","article-title":"The TIGR triangle of the pineal region: a virtual reality anatomic study","volume":"165","author":"Saez-Alegre","year":"2023","unstructured":"Saez-Alegre MRios-Vicil CIAlvarez ASSagrati JPiper KJean WC.The TIGR triangle of the pineal region: a virtual reality anatomic study. Acta Neurochir (Wien). 2023;165(12):4083-4091."},{"issue":"7697","key":"bib13","series-title":"Nature","first-page":"469","article-title":"DNA methylation-based classification of central nervous system tumours","volume":"555","author":"Capper","year":"2018","unstructured":"Capper DJones DTWSill MDNA methylation-based classification of central nervous system tumours. Nature. 2018;555(7697):469-474."},{"issue":"2","key":"bib14","series-title":"J Neurooncol","first-page":"327","article-title":"Radiographic assessment of contrast enhancement and T2\/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups","volume":"141","author":"Juratli","year":"2019","unstructured":"Juratli TATummala SSRiedl ARadiographic assessment of contrast enhancement and T2\/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups. J Neurooncol. 2019;141(2):327-335."},{"issue":"12","key":"bib15","series-title":"Radiol Case Rep","first-page":"6436","article-title":"High-grade astrocytoma with piloid features: MRI findings associated with a novel entity","volume":"19","author":"Mughal","year":"2024","unstructured":"Mughal AURKhan MN.High-grade astrocytoma with piloid features: MRI findings associated with a novel entity. Radiol Case Rep. 2024;19(12):6436-6439."},{"issue":"18","key":"bib16","series-title":"J Neurosurg Case Lessons","first-page":"CASE24390","article-title":"High-grade astrocytoma with piloid features in the conus medullaris: a rare presentation of a new World Health Organization diagnosis. Illustrative case","volume":"8","author":"Ndirangu","year":"2024","unstructured":"Ndirangu BNeill SCory Adamson DC.High-grade astrocytoma with piloid features in the conus medullaris: a rare presentation of a new World Health Organization diagnosis. Illustrative case. J Neurosurg Case Lessons. 2024;8(18):CASE24390."},{"issue":"18","key":"bib17","series-title":"J Neurosurg Case Lessons","first-page":"CASE24778","article-title":"Reclassification of pineal tumor as high-grade astrocytoma with piloid features through methylation profiling: illustrative case","volume":"9","author":"Dincer","year":"2025","unstructured":"Dincer AKim MH\u00fcseyinoglu ZMillares Chavez MMcGuone DMoliterno J.Reclassification of pineal tumor as high-grade astrocytoma with piloid features through methylation profiling: illustrative case. J Neurosurg Case Lessons. 2025;9(18):CASE24778."},{"issue":"suppl 5","key":"bib18","series-title":"Neuro Oncol","first-page":"v244","article-title":"QLTI-01. High-grade astrocytoma with piloid features response to treatment with carboplatin and vincristine","volume":"25","author":"Cielo","year":"2023","unstructured":"Cielo B.QLTI-01. High-grade astrocytoma with piloid features response to treatment with carboplatin and vincristine. Neuro Oncol. 2023;25(suppl 5):v244-v245."},{"key":"bib19","series-title":"Adv Tech Stand Neurosurg","first-page":"207","article-title":"Purely endoscopic supracerebellar infratentorial approach to the pineal region in pediatric population","volume":"52","author":"Ali","year":"2024","unstructured":"Ali SElbabaa SK.Purely endoscopic supracerebellar infratentorial approach to the pineal region in pediatric population. Adv Tech Stand Neurosurg. 2024;52:207-227."},{"issue":"2","key":"bib20","series-title":"J Neurosurg","first-page":"197","article-title":"The infratentorial supracerebellar approach to pineal lesions","volume":"35","author":"Stein","year":"1971","unstructured":"Stein BM.The infratentorial supracerebellar approach to pineal lesions. J Neurosurg. 1971;35(2):197-202."},{"issue":"2","key":"bib21","series-title":"Neurochirurgia (Stuttg)","first-page":"59","article-title":"Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case","volume":"19","author":"Voigt","year":"1976","unstructured":"Voigt KYa\u015fargil MG.Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia (Stuttg). 1976;19(2):59-68."},{"issue":"5","key":"bib22","series-title":"Neurosurg Rev","first-page":"3327","article-title":"Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach\u2014surgical strategies, complications, and their avoidance","volume":"45","author":"Fleck","year":"2022","unstructured":"Fleck SDamaty AELange IPineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach\u2014surgical strategies, complications, and their avoidance. Neurosurg Rev. 2022;45(5):3327-3337."},{"issue":"1","key":"bib23","series-title":"Trials","first-page":"492","article-title":"The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial","volume":"23","author":"Wu","year":"2022","unstructured":"Wu XWang XSong GThe effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial. Trials. 2022;23(1):492."},{"issue":"5","key":"bib24","series-title":"Eur J Anaesthesiol","first-page":"285","article-title":"The sitting position in anaesthesia: old and new","volume":"31","author":"J\u00fcrgens","year":"2014","unstructured":"J\u00fcrgens SBasu S.The sitting position in anaesthesia: old and new. Eur J Anaesthesiol. 2014;31(5):285-287."},{"issue":"4","key":"bib25","series-title":"J Neurosurg","first-page":"860","article-title":"Functional outcome after complete surgical removal of giant vestibular schwannomas","volume":"112","author":"Samii","year":"2010","unstructured":"Samii MGerganov VMSamii A.Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg. 2010;112(4):860-867."},{"key":"bib26","series-title":"Surg Neurol Int","first-page":"244","article-title":"Ergonomics of surgical microscopes for the sitting position as determined by ocular-corpus length","volume":"11","author":"Goehre","year":"2020","unstructured":"Goehre FLudtka CSchwan S.Ergonomics of surgical microscopes for the sitting position as determined by ocular-corpus length. Surg Neurol Int. 2020;11:244."},{"issue":"2","key":"bib27","series-title":"World Neurosurg","first-page":"257","article-title":"Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches","volume":"84","author":"Zaidi","year":"2015","unstructured":"Zaidi HAElhadi AMLei TPreul MCLittle ASNakaji P.Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches. World Neurosurg. 2015;84(2):257-266."},{"issue":"2","key":"bib28","series-title":"J Clin Neurosci","first-page":"306","article-title":"Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM\u00ae)","volume":"19","author":"Mamelak","year":"2012","unstructured":"Mamelak ANDrazin DShirzadi ABlack KLBerci G.Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM\u00ae). J Clin Neurosci. 2012;19(2):306-309."},{"issue":"2","key":"bib1","series-title":"Acta Neuropathol","first-page":"273","article-title":"Anaplastic astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A\/B and ATRX alterations","volume":"136","author":"Reinhardt","year":"2018","unstructured":"Reinhardt AStichel DSchrimpf DAnaplastic astrocytoma with piloid features, a novel molecular class of IDH wildtype glioma with recurrent MAPK pathway, CDKN2A\/B and ATRX alterations. Acta Neuropathol. 2018;136(2):273-291."},{"issue":"1","key":"bib2","series-title":"J Neurooncol","first-page":"109","article-title":"High-grade astrocytoma with piloid features (HGAP): the Charit\u00e9 experience with a new central nervous system tumor entity","volume":"153","author":"Bender","year":"2021","unstructured":"Bender KPerez EChirica MHigh-grade astrocytoma with piloid features (HGAP): the Charit\u00e9 experience with a new central nervous system tumor entity. J Neurooncol. 2021;153(1):109-120."},{"issue":"8","key":"bib3","series-title":"Neuro Oncol","first-page":"1231","article-title":"The 2021 WHO Classification of Tumors of the central nervous system: a summary","volume":"23","author":"Louis","year":"2021","unstructured":"Louis DNPerry AWesseling PThe 2021 WHO Classification of Tumors of the central nervous system: a summary. Neuro Oncol. 2021;23(8):1231-1251."},{"issue":"4","key":"bib4","series-title":"AJNR Am J Neuroradiol","first-page":"367","article-title":"Newly recognized CNS tumors in the 2021 World Health Organization classification: imaging overview with histopathologic and genetic correlation","volume":"44","author":"Rigsby","year":"2023","unstructured":"Rigsby RKBrahmbhatt PDesai ABNewly recognized CNS tumors in the 2021 World Health Organization classification: imaging overview with histopathologic and genetic correlation. AJNR Am J Neuroradiol. 2023;44(4):367-380."},{"issue":"8","key":"bib5","series-title":"Neuro Oncol","first-page":"1474","article-title":"Clinical, histological, and molecular features of gliomas in adults with neurofibromatosis type 1","volume":"25","author":"Romo","year":"2023","unstructured":"Romo CGPiotrowski AFCampian JLClinical, histological, and molecular features of gliomas in adults with neurofibromatosis type 1. Neuro Oncol. 2023;25(8):1474-1486."},{"issue":"1","key":"bib6","series-title":"Acta Neuropathol","first-page":"71","article-title":"Expanded analysis of high-grade astrocytoma with piloid features identifies an epigenetically and clinically distinct subtype associated with neurofibromatosis type 1","volume":"145","author":"Cimino","year":"2023","unstructured":"Cimino PJKetchum CTurakulov RExpanded analysis of high-grade astrocytoma with piloid features identifies an epigenetically and clinically distinct subtype associated with neurofibromatosis type 1. Acta Neuropathol. 2023;145(1):71-82."},{"issue":"4","key":"bib7","series-title":"Cureus","first-page":"e58697","article-title":"Obstructive hydrocephalus due to aggressive posterior fossa tumor exhibiting histological characteristics of pilocytic astrocytoma in two adult neurofibromatosis type 1 (NF1) cases","volume":"16","author":"Nawa","year":"2024","unstructured":"Nawa SOhka FMotomura KObstructive hydrocephalus due to aggressive posterior fossa tumor exhibiting histological characteristics of pilocytic astrocytoma in two adult neurofibromatosis type 1 (NF1) cases. Cureus. 2024;16(4):e58697."},{"issue":"4","key":"bib8","series-title":"AJNR Am J Neuroradiol","first-page":"468","article-title":"High-grade astrocytoma with piloid features: a dual institutional review of imaging findings of a novel entity","volume":"45","author":"Soni","year":"2024","unstructured":"Soni NAgarwal AAjmera PHigh-grade astrocytoma with piloid features: a dual institutional review of imaging findings of a novel entity. AJNR Am J Neuroradiol. 2024;45(4):468-474."},{"issue":"1","key":"bib9","series-title":"Clin Neuroradiol","first-page":"279","article-title":"Freiburg Neuropathology Case Conference: 68-year-old patient with slurred speech, double vision, and increasing gait disturbance","volume":"34","author":"Zander","year":"2024","unstructured":"Zander CDiebold MShah MJFreiburg Neuropathology Case Conference: 68-year-old patient with slurred speech, double vision, and increasing gait disturbance. Clin Neuroradiol. 2024;34(1):279-286."},{"key":"bib10","series-title":"Arch Pathol Lab Med","article-title":"High-grade astrocytoma with piloid features","author":"Rudolf","year":"2025","unstructured":"Rudolf MAFerris SP.High-grade astrocytoma with piloid features. Arch Pathol Lab Med. 2025."},{"issue":"1","key":"bib11","series-title":"Neurosurg Focus Video","first-page":"V3","article-title":"Feasibility of exoscopic keyhole surgery: case series","volume":"10","author":"S\u00e1ez-Alegre","year":"2024","unstructured":"S\u00e1ez-Alegre MR\u00edos-Vicil CPiper KNajera EJean WC.Feasibility of exoscopic keyhole surgery: case series. Neurosurg Focus Video. 2024;10(1):V3."},{"issue":"12","key":"bib12","series-title":"Acta Neurochir (Wien)","first-page":"4083","article-title":"The TIGR triangle of the pineal region: a virtual reality anatomic study","volume":"165","author":"Saez-Alegre","year":"2023","unstructured":"Saez-Alegre MRios-Vicil CIAlvarez ASSagrati JPiper KJean WC.The TIGR triangle of the pineal region: a virtual reality anatomic study. Acta Neurochir (Wien). 2023;165(12):4083-4091."},{"issue":"7697","key":"bib13","series-title":"Nature","first-page":"469","article-title":"DNA methylation-based classification of central nervous system tumours","volume":"555","author":"Capper","year":"2018","unstructured":"Capper DJones DTWSill MDNA methylation-based classification of central nervous system tumours. Nature. 2018;555(7697):469-474."},{"issue":"2","key":"bib14","series-title":"J Neurooncol","first-page":"327","article-title":"Radiographic assessment of contrast enhancement and T2\/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups","volume":"141","author":"Juratli","year":"2019","unstructured":"Juratli TATummala SSRiedl ARadiographic assessment of contrast enhancement and T2\/FLAIR mismatch sign in lower grade gliomas: correlation with molecular groups. J Neurooncol. 2019;141(2):327-335."},{"issue":"12","key":"bib15","series-title":"Radiol Case Rep","first-page":"6436","article-title":"High-grade astrocytoma with piloid features: MRI findings associated with a novel entity","volume":"19","author":"Mughal","year":"2024","unstructured":"Mughal AURKhan MN.High-grade astrocytoma with piloid features: MRI findings associated with a novel entity. Radiol Case Rep. 2024;19(12):6436-6439."},{"issue":"18","key":"bib16","series-title":"J Neurosurg Case Lessons","first-page":"CASE24390","article-title":"High-grade astrocytoma with piloid features in the conus medullaris: a rare presentation of a new World Health Organization diagnosis. Illustrative case","volume":"8","author":"Ndirangu","year":"2024","unstructured":"Ndirangu BNeill SCory Adamson DC.High-grade astrocytoma with piloid features in the conus medullaris: a rare presentation of a new World Health Organization diagnosis. Illustrative case. J Neurosurg Case Lessons. 2024;8(18):CASE24390."},{"issue":"18","key":"bib17","series-title":"J Neurosurg Case Lessons","first-page":"CASE24778","article-title":"Reclassification of pineal tumor as high-grade astrocytoma with piloid features through methylation profiling: illustrative case","volume":"9","author":"Dincer","year":"2025","unstructured":"Dincer AKim MH\u00fcseyinoglu ZMillares Chavez MMcGuone DMoliterno J.Reclassification of pineal tumor as high-grade astrocytoma with piloid features through methylation profiling: illustrative case. J Neurosurg Case Lessons. 2025;9(18):CASE24778."},{"issue":"suppl 5","key":"bib18","series-title":"Neuro Oncol","first-page":"v244","article-title":"QLTI-01. High-grade astrocytoma with piloid features response to treatment with carboplatin and vincristine","volume":"25","author":"Cielo","year":"2023","unstructured":"Cielo B.QLTI-01. High-grade astrocytoma with piloid features response to treatment with carboplatin and vincristine. Neuro Oncol. 2023;25(suppl 5):v244-v245."},{"key":"bib19","series-title":"Adv Tech Stand Neurosurg","first-page":"207","article-title":"Purely endoscopic supracerebellar infratentorial approach to the pineal region in pediatric population","volume":"52","author":"Ali","year":"2024","unstructured":"Ali SElbabaa SK.Purely endoscopic supracerebellar infratentorial approach to the pineal region in pediatric population. Adv Tech Stand Neurosurg. 2024;52:207-227."},{"issue":"2","key":"bib20","series-title":"J Neurosurg","first-page":"197","article-title":"The infratentorial supracerebellar approach to pineal lesions","volume":"35","author":"Stein","year":"1971","unstructured":"Stein BM.The infratentorial supracerebellar approach to pineal lesions. J Neurosurg. 1971;35(2):197-202."},{"issue":"2","key":"bib21","series-title":"Neurochirurgia (Stuttg)","first-page":"59","article-title":"Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case","volume":"19","author":"Voigt","year":"1976","unstructured":"Voigt KYa\u015fargil MG.Cerebral cavernous haemangiomas or cavernomas. Incidence, pathology, localization, diagnosis, clinical features and treatment. Review of the literature and report of an unusual case. Neurochirurgia (Stuttg). 1976;19(2):59-68."},{"issue":"5","key":"bib22","series-title":"Neurosurg Rev","first-page":"3327","article-title":"Pineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach\u2014surgical strategies, complications, and their avoidance","volume":"45","author":"Fleck","year":"2022","unstructured":"Fleck SDamaty AELange IPineal cysts without hydrocephalus: microsurgical resection via an infratentorial-supracerebellar approach\u2014surgical strategies, complications, and their avoidance. Neurosurg Rev. 2022;45(5):3327-3337."},{"issue":"1","key":"bib23","series-title":"Trials","first-page":"492","article-title":"The effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial","volume":"23","author":"Wu","year":"2022","unstructured":"Wu XWang XSong GThe effects of different surgical positions (semi-sitting and lateral position) on the surgical outcomes of large vestibular schwannoma: study protocol for a randomized controlled trial. Trials. 2022;23(1):492."},{"issue":"5","key":"bib24","series-title":"Eur J Anaesthesiol","first-page":"285","article-title":"The sitting position in anaesthesia: old and new","volume":"31","author":"J\u00fcrgens","year":"2014","unstructured":"J\u00fcrgens SBasu S.The sitting position in anaesthesia: old and new. Eur J Anaesthesiol. 2014;31(5):285-287."},{"issue":"4","key":"bib25","series-title":"J Neurosurg","first-page":"860","article-title":"Functional outcome after complete surgical removal of giant vestibular schwannomas","volume":"112","author":"Samii","year":"2010","unstructured":"Samii MGerganov VMSamii A.Functional outcome after complete surgical removal of giant vestibular schwannomas. J Neurosurg. 2010;112(4):860-867."},{"key":"bib26","series-title":"Surg Neurol Int","first-page":"244","article-title":"Ergonomics of surgical microscopes for the sitting position as determined by ocular-corpus length","volume":"11","author":"Goehre","year":"2020","unstructured":"Goehre FLudtka CSchwan S.Ergonomics of surgical microscopes for the sitting position as determined by ocular-corpus length. Surg Neurol Int. 2020;11:244."},{"issue":"2","key":"bib27","series-title":"World Neurosurg","first-page":"257","article-title":"Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches","volume":"84","author":"Zaidi","year":"2015","unstructured":"Zaidi HAElhadi AMLei TPreul MCLittle ASNakaji P.Minimally invasive endoscopic supracerebellar-infratentorial surgery of the pineal region: anatomical comparison of four variant approaches. World Neurosurg. 2015;84(2):257-266."},{"issue":"2","key":"bib28","series-title":"J Clin Neurosci","first-page":"306","article-title":"Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM\u00ae)","volume":"19","author":"Mamelak","year":"2012","unstructured":"Mamelak ANDrazin DShirzadi ABlack KLBerci G.Infratentorial supracerebellar resection of a pineal tumor using a high definition video exoscope (VITOM\u00ae). J Clin Neurosci. 2012;19(2):306-309."}],"container-title":["Journal of Neurosurgery: Case Lessons"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/10\/article-CASE25390.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/10\/article-CASE25390.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-case-lessons\/10\/10\/article-CASE25390.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T11:12:22Z","timestamp":1769685142000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-case-lessons\/10\/10\/article-CASE25390.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,8]]},"references-count":56,"journal-issue":{"issue":"10"},"URL":"https:\/\/doi.org\/10.3171\/case25390","relation":{},"ISSN":["2694-1902"],"issn-type":[{"value":"2694-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,8]]}}}