To investigate the expanded application of Poppen approach in the CNS (central nervous system) tumors.

From January 2004 to June 2018, 311 patients with CNS tumors underwent operation through Poppen approach at Department of Neurosurgery, Nanfang Hospital of Southern Medical University. Their clinical data were retrospectively reviewed. There were 221 cases originating from the pineal region, 23 cases from the thalamus, 31 cases from the midbrain, 7 cases from the cerebellum and 29 cases from the tentorium cerebelli. Postoperative MRI examination was regularly performed to evaluate the extent of tumor resection.

A total of 316 operations, including 3 re-operations due to tumor recurrence and 2 re-operations due to residual tumor, were successfully performed in 311 patients. Postoperative MRI revealed that total resection was achieved in 280 (90.0%) cases, subtotal resection in 10 (3.2%) and partial resection in 21 (6.8%). Among 208 patients suffering from preoperative hydrocephalus, 177 (85.1%) achieved symptomatic improvement after operation. Among 103 patients without preoperative hydrocephalus or with improved hydrocephalus after conservative treatment, 13 (12.6%) suffered from postoperative hydrocephalus. Out of all 311 patients, 3 suffered from postoperative hemiplegia with improved symptoms to different degrees at discharge, and 4 suffered from postoperative coma and included 2 with stable conditions whose families refused therapy and 2 with critical conditions at discharge. There were 5 cases of death due to different causes, including 1 case of acute hydrocephalus who did not undergo timely treatment, 1 case of intracranial infection due to external drainage for hydrocephalus, 1 case of severe cerebral swelling because of damage of the venous system, and 2 cases of multiple organ dysfunction syndrome. According to postoperative pathological examinations, there were 118 cases of germ cell tumor, 72 cases of neuroepithelial tumor, 51 cases of pinealoma, 29 cases of meningioma and 41 cases of other rare types.

The Poppen approach can be extensively applied in the tumors in the areas of thalamus, brain stem tumors and cerebellum in addition to those in the pineal region with favorable outcomes.

Brain neoplasms; Microsurgery; Treatment outcome; Poppen approach