Cavernoma in the pineal region

Microsurgical Management of Vascular Malformations of the Pineal Region

“…12 However, we have to recognize that some big surgical series of pineal lesions include no mentioned cavernous malformations. 11,13,14,29,[38][39][40][41][42][43] Those vascular lesions are often misdiagnosed with germ cell tumors, choriocarcinomas (recurrent bleeding) or hemorrhagic pineal cysts, particularly when the clinical manifestation is related with intracranial hemorrhage. In those cases, MRI studies show mixed signals without hemosiderin rim on the T1-and T2-weighted MRI, differently from a non-hemorrhagic cavernoma.…”

“…In this regards a direct microsurgical excision of the vascular malformation is the standard treatment. 13,14 The approaches that are generally used to access the pineal region include: the supracerebellar infratentorial approach, and the occipital transtentorial approach. 11,13,14,29,[38][39][40][41][42] In the posterior routes to the pineal regions, the sitting position may offer several advantages over the horizontal position, and several protocols may be effectively used in the clinical setting in order to prevent its major complications.…”

“…13,14 The approaches that are generally used to access the pineal region include: the supracerebellar infratentorial approach, and the occipital transtentorial approach. 11,13,14,29,[38][39][40][41][42] In the posterior routes to the pineal regions, the sitting position may offer several advantages over the horizontal position, and several protocols may be effectively used in the clinical setting in order to prevent its major complications. 1,2,29,[44][45][46][47][48][49][50] Whatever approach is selected, skillful and clean microneurosurgery preserving the normal anatomy is imperative during pineal region operations.…”

“…Nevertheless, sometimes, when endovascular managements fail and/or if other alternatives are not available, microsurgical treatment may be indicated. [4][5][6][7][8][9][10][11][12][13][14] We present a retrospective review of the patients with vascular pineal malformations operated by the senior author (JH). Moreover, we report illustrative cases for the various types of vascular lesions with a careful analysis of the different microsurgical stages.…”

Occipital interhemispheric transtentorial approach to the superior cerebellum

“…In general, the supracerebellar infratentorial approach is used more frequently in patients with cerebellar hemangioblastomas 2 and is also used to access the pineal region. 4 Very few studies have described the use of the occipital interhemispheric transtentorial approach for accessing cerebellar lesions.…”