Combined Microscopic and Endoscopic Surgery for Pineal Region Meningiomas Using the Occipital-Parietal Transtentorial Approach

Abstract

ObjectivePineal region meningiomas are deeply located and adjacent to critical neurovascular structures, making them one of the most challenging areas to access. The authors presented a combined microscopic and endoscopic surgery and investigated its value in resecting pineal region meningiomas.MethodsTwelve patients with pineal region meningiomas from February 2017 to December 2020 were retrospectively reviewed. All patients underwent combined microscopic and endoscopic surgery using the occipital-parietal transtentorial approach. Perioperative clinical, surgical, and radiographic data were collected.ResultsThe endoscope provided a wider view and increased visualization of residual tumors. All tumors were completely resected, and none of the patients died. Total resection was believed to have been achieved in four patients, but the residual tumor was detected after endoscopic exploration and was completely resected with an endoscope. Only one patient had transient visual field deficits. No recurrence was observed during follow-up.ConclusionsCombined microscopic-endoscopic surgery for pineal region meningiomas eliminates microscopic blind spots, thus compensating for the shortcomings of the traditional occipital transtentorial approach. It is a promising technique for minimally invasive maximal resection of pineal region meningiomas.

Combined supracerebellar infratentorial and right occipital interhemispheric approach to falcotentorial junction meningioma: A case report

“…[14] e supratentorial and infratentorial regions are both exposed by the occipital transtentorial/transfalcine approach and its modifications. [6,19] For a superiorly located falcotentorial meningioma, endoscopicassisted microsurgical excision could be performed using the posterior interhemispheric retrocallosal transfalcine approach. e combination bioccipital suboccipital transsinus transtentorial technique, which involves dividing the less dominant transverse sinus, was described by Liu and Cohen.…”

“…Treatment options for falcotentorial meningioma include supracerebellar infratentorial, occipital interhemispheric, occipital transtentorial, anterior interhemispheric transsplenial, or a combination of supra and infratentorial transsinus, midline occipital, and suboccipital approaches. [ 3 , 5 , 6 , 8 - 10 , 13 , 15 , 19 ] The rate of complications related to the approach itself continues to be significant because the ventral side of the falcotentorial margins and the cranial side of the vein of Galen confluence are blind areas.…”

“…[ 3 ] Pineal region meningiomas are classified into two subtypes based on tumor origin: falcotentorial and velum interpositum meningiomas. [ 6 ] Falcotentorial meningiomas are uncommon tumors of the pineal area that grow from the dural folds where the tentorium and falx meet. Falcotentorial junction meningiomas are relatively rare, accounting for only 0, 3–2% of all meningiomas.…”

“…[ 7 ] The pineal gland, midbrain, vein of Galen, straight sinus, and third ventricle are among the adjacent structures that are compressed by falcotentorial meningiomas. [ 5 , 6 ] Most of these tumors have a slow rate of growth,[ 5 ] and they often manifest symptoms of brainstem compression and intracranial hypertension. [ 10 ] This region’s tumors present with hydrocephalus, cerebellar, ophthalmologic, endocrinologic, and cognitive disturbances.…”

“…[ 15 , 19 ] Each of these approaches has blind spot-related limitations and complications, though. [ 6 , 15 ] In this case, we present the falcotentorial meningioma, which successfully underwent a combined supra and infratentorial approach.…”