Falcotentorial and velum interpositum meningiomas: Two distinct entities of the pineal region

Abstract

The falcotentorial and velum interpositum meningiomas can be safely managed with the use of occipital transtentorial approach. Homonymous hemianopsia is the most common although always transient complication of surgery.

Meningioma of the Pineal Region — Differential Radiologic Aspects of Pineal Region Tumors Based on a Clinical Case

“…7 The best approach to the pineal region (transtentorial or infratentorial supracerebellar) remains a matter of debate in the literature, 2,7 but preservation of the vascular structures (internal and basal cerebral veins, Galen veins, for instance) is more important than complete removal of the tumor. 2 In the present case, the Galen system was pushed downwardly, thus, the transtentorial route was elected.…”

“…They originate in the posterior portion of this structure, formed by two layers of pia mater, which constitute the floor of the third ventricle and contains the internal cerebral veins and their tributaries and medial posterior choroidal arteries. 2 In this case, the meningioma had no dural attachment, which leads to the diagnosis of velum interpositum meningioma.…”

“…7 Parinaud syndrome (paralysis of vertical gaze, convergence-retraction nystagmus, abnormal pupils with unreactive photomotor reflex) is described in up to 10% of the cases of pineal region meningioma; changes in extrinsic ocular movement are rare in meningiomas of the pineal region, aiding their differentiation from other tumors of this area for which these findings are more common. 2 Other presentations described include hemifacial spasm, hypoacusis and early puberty. 5,7,8 In the present case, the time elapsed between symptom onset and diagnosis was similar to the period reported in the literature.…”

“…1 Meningiomas of the pineal region are rare entities and make up 2 to 8% of all tumors found in this area. 2 The pineal region is the most heterogeneous in the central nervous system in terms of histological types of tumor, 3 and imaging exams can help to confirm the diagnosis besides helping to define the approach and plan of operation. 4 Germinomas can secrete markers such as β human chorionic gonadotropin (β-HCG) and α-fetoprotein (α-FP), whose presence can preclude the need for surgical biopsy.…”

Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space

“…Among these are falcotentorial meningiomas which involve the posterior incisural space. These lesions are extremely rare, comprising 1% of all meningiomas,[10,20] and are intrinsically difficult to resect as they lie in close proximity to the above-mentioned critical vascular and neural structures. The parietal-occipital craniotomy, which offers a standard parafalcine approach to access falcotentorial meningiomas, carries the risk of injury to the optical apparatus from occipital lobe retraction, which often results in visual deficits including permanent blindness.…”