Falcotentorial meningioma: surgical outcome in 14 patients

Goto, Takeo; Ohata, Kenji; Morino, Michiharu; Takami, Toshihiro; Tsuyuguchi, Naohiro; Nishio, Akimasa; Hara, Mitsuhiro

doi:10.3171/jns.2006.104.1.47

Cited by 39 publications

(39 citation statements)

References 15 publications

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“…Biopsy, before the initiation of therapy has been recommended in the more recent literature. In present time, neuroendoscopic approach has been proposed as the fi rst choice in the strategy to achieve the especifi c diagnosis of pineal region tumours 29 . Neuroendoscopic approach affords a minimally invasive way to treat obstructive hydrocephalus by third ventriculostomy and obtain biopsy specimens and tissue diagnosis.…”

Section: Discussionmentioning

confidence: 99%

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Meningiomas of pineal region in children

Matushita

Pinto

Plese

2007

Arq. Neuro-Psiquiatr.

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-Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.KEY WORDS: meningiomas, meningeal neoplams, pineal tumors, velum interpositum, falcotentorial junction, children. Meningiomas da região da pineal em criançasRESUMO -Meningiomas são tumores poucos frequentes em crianças, e mais raramente encontrados na região da pineal. Relatamos dois casos de meningioma da região da pineal em crianças, uma menina de cinco anos e um menino de um ano de idade. Não foi identificada nenhuma forma de apresentação clinica ou caracteristica tomográfica, antes do tratamento, que sugerisse o diagnóstico de meningioma. As características clinicas e laboratoriais encontradas foram similares às de tumores mais frequentes da região da pineal. Ambos os pacientes foram submetidos ao tratamento cirúrgico e a remoção completa foi obtida por abordagem suboccipital transtentorial. Durante o seguimento, um dos pacientes foi reoperado por recorrencia do tumor seis anos após o tratamento inicial. Atualmente, os pacientes encontram-se livres de recorrência tumoral.PALAVRAS-CHAVE: meningioma, neoplasia meningea, velum interpositum, junção falcotentorial, crianças. Dr. Hamilton Matushita -Rua Barata Ribeiro 237 / 43/44/46 -01308-000 São Paulo SP -Brasil. E-mail: neurosp@uol.com.brLiterature specifically concerning to meningioma of the pineal region in children is scarce. Meningiomas are relatively common tumors in adults and account for approximately 20% of all intracranial tumors 1 . Their incidence ranges from 1.1% to 4.2% of all intracranial tumor in pediatric age and in this corresponds to a proportion varying from 2,8% to 5,9% of meningiomas in all ages 2, 3 . Meningiomas in children predominate during the second decade and are extremely uncommon in infancy. In children, meningiomas appear in unusual sites and usually reach enormous sizes, and locations that are rare in adults 2,3 . Meningiomas in the pineal region may originate either from the velum interpositum or from the falcotentorial junction.We are describing our experience with two cases of meningiomas in the pineal region in children arising within the velum interpositum, with no dural attachment. Lack of dural...

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Section: Discussionmentioning

confidence: 99%

“…The deep Galenic system and the anterior part of the straight sinus offer the challenge to remove this tumors totally. Oclusion of both the vein of Galen or the straight and sagital sinus by the tumors are very frequent 10,11,[29][30][31] . Previous knowledge about the collateral venous drainage is very important to avoid complications.…”

Section: Discussionmentioning

confidence: 99%

Meningiomas of pineal region in children

Matushita

Pinto

Plese

2007

Arq. Neuro-Psiquiatr.

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“…In addition, the drainage pattern of the inferior cerebral venous system and the relationship of the tumor to the midline deep venous system must be evaluated preoperatively. 8,12 Cerebral computed tomography venography may provide similar information. Finally, angiography may be used in select cases to delineate the arterial and venous structures in relation to the tumor.…”

Section: Radiologic Considerationsmentioning

confidence: 92%

“…According to Goto et al, 12 tumors arising above the galenic system which push the vein of Galen and basal vein downward have a thick double layer of arachnoid between them and are safely dissected free. On the other hand, tumors below the galenic system, which push the veins upward have no arachnoid plane separating the two.…”

Section: Falcotentorial Meningiomasmentioning

confidence: 99%

Tentorial Meningiomas

Aziz¹,

Bhatia

Froelich³

et al. 2009

Neurosurgery Quarterly

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Three-dimensional understanding of the pathologic and radiologic anatomy of tentorial meningiomas is the basis for our proposed classification, which provides the rationale for surgical approach for each tentorial location. Safe resection is the surgical goal, whether gross or subtotal resection is used. For each group of tentorial meningioma classified (anterior incisural, middle incisural, falcotentorial, posterolateral and posteromedial, torcular) and the subtypes, consideration is given to the optimal surgical corridor. Particular topics discussed include careful interpretation of the preoperative venous sinus to determine the extent of tumor involvement; devascularization, debulking, and dissection of the tumor with preservation of the arachnoidal plane; and resection of the dural origin as completely as possible.M eningiomas originating from the tentorium account for 3% to 6% of all intracranial meningiomas. 1 In Cushing's series of 295 meningiomas, 11 (3.7%) were attached to the tentorium. 2 Because of complex arterial, venous, and neural anatomy of this region, complete microsurgical excision of these tumors can be a challenging task. Three-dimensional understanding of the pathologic and radiologic anatomy of tentorial meningiomas is required for selecting and classifying the appropriate surgical approach of each tentorial meningioma. MICROSURGICAL ANATOMY Dural AnatomyThe cranial dura consists of 2 layers, an outer periosteal layer and an inner meningeal layer. The meningeal layer separates from the periosteal layer at several places to allow for the venous sinuses and to form several septations that divide and support the brain. One of these divisions is the tentorium that roofs over the cerebellum and forms a free edge around the brainstem, allowing communication between the supratentorial and infratentorial compartments, is called the tentorial incisura. The incisura is a somewhat triangular opening with its base on the dorsum sellae and its apex dorsal to the midbrain. The tentorium slopes down from the apex to its bony attachments.The lateral edge of the tentorium is attached to the petrous ridge where it encloses the superior petrosal sinus. The posterior edge is attached to the inner surface of the occipital bone; it divides along the internal occipital protuberance and the edges of the shallow osseous groove to form the torcular Herophili and transverse sinuses.The anterior end of the free tentorial edge is attached to the petrous apex and the anterior and posterior clinoid processes, forming 3 dural folds, the anterior and posterior petroclinoidal and the interclinoidal folds. The anterior petroclinoid fold extends from the petrous apex to the anterior clinoid process, the posterior petroclinoid fold extends from the petrous apex to the posterior clinoid process, and the interclinoidal fold extends between the anterior and posterior clinoid processes. Together these 3 folds form the boundaries of the oculomotor trigone, through which the oculomotor and the trochlear nerves enter the cavernous si...

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“…In some locations, e.g. falcotentorial, the relationship between the tumour and the adjacent veins determines the operative risk and surgical trajectory [2]. Since damage to bridging veins can lead to venous congestion and haemorrhage, knowledge of location, displacement, and patency is needed to plan the surgical strategy [3].…”

Section: Introductionmentioning

confidence: 99%

Dynamic 3-D contrast-enhanced angiography of cerebral tumours and vascular malformations

et al. 2007

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We describe the applicability and clinical use of dynamic 3-D contrast-enhanced MR subtraction angiography performed at 3 T with parallel imaging and intelligent k-space readout for imaging both treated and untreated cerebral arteriovenous malformations (AVMs), AV fistulae (AVFs) and brain tumours. An in-plane submillimetre spatial resolution with temporal resolution of one image per 1.3 s was obtained. The spatial resolution was comparable to that of other MRA techniques (i.e. TOF or PC MRA) while the scanning time was markedly reduced and the evaluation of both the arterial and venous vessels was possible with the same imaging sequence. Additional clinical information could be obtained for a variety of CNS disorders. Concerning AVMs, dynamic contrast-enhanced 3-D MRA helped to identify the arterial feeders, the shunting volume, and the location and size of the nidus. However, we found that the most important clinical application was the assessment of shunt occlusion following treatment (i.e. radiosurgery, surgery, or embolization) by determining the absence or presence of early venous filling following injection of contrast agent. Moreover, our MRA technique helped to noninvasively diagnose and classify arteriovenous dural shunts with regard to shunting volume, arterial feeders, and, most importantly, venous drainage pattern. For preoperative imaging of meningeomas, displacement of normal arteries, depiction of tumour feeders and anatomy of the venous system including the tributaries to the large sinuses, their patency, the location of bridging veins, and the extent of tumour vascularization could be assessed. Our findings indicate that dynamic 3-D MRA can help to reduce the scanning time by eliminating additional TOF or PC MRA sequences. With the same imaging sequence, both arterial and venous information can be obtained in a short period of time. In addition, haemodynamic information can be obtained, which may be of importance for a variety of clinical questions. The number of invasive examinations can be reduced during follow-up after treatment of AVF or AVM, and the need to treat dural AV shunts can be assessed noninvasively. In the preoperative investigation of meningeomas, all pertinent information (degree of vascularization, tumour feeders, displacement of arteries, and assessment of large veins) is obtained using a single sequence. We conclude that this MRA sequence may be an alternative to current MRA approaches and will prove an important adjunct for the diagnosis of a variety of neurovascular disorders.

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Falcotentorial meningioma: surgical outcome in 14 patients

Abstract: . Classification of the tumor location by preoperative neuroimaging studies can be helpful in estimating the surgical difficulty that might be encountered in treating the falcotentorial junction meningioma.

Cited by 39 publications

References 15 publications

Meningiomas of pineal region in children

Meningiomas of pineal region in children

Tentorial Meningiomas

Dynamic 3-D contrast-enhanced angiography of cerebral tumours and vascular malformations

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