Successful removal of large pineal region meningiomas: two case reports

Mallucci, Conor; Obukhov, Sergei K.

doi:10.1016/0090-3019(95)00220-0

Cited by 14 publications

(8 citation statements)

References 10 publications

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“…The meningioma in the pineal region accounts are uncommon, but because of the benign biological behavior of meningiomas in the pineal region and its good prognosis, it is still worthy of study in order to define a standard surgical approach that will benefit patients [2,11,12]. When a pineal region meningioma grows bilaterally to the tentorial plane and extends laterally, the large variation of the tentorial angle will result in a complicated anatomical relationship between the tumor, the tentorium and the falx [13].…”

Section: Discussionmentioning

confidence: 99%

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Zhao

Wang

et al. 2011

World J Surg Onc

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BackgroundThere are several treatment approaches for pineal region meningiomas, such as Poppen's approach, Krause's approach and combinations of the two approaches. We present our experience with the use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using a suboccipital transtentorial approach (Poppen's approach) and evaluate the role of Poppen's approach.MethodsDuring the period from January 2005 to June 2010, ten patients presented to us with pineal region meningioma. MRI was routinely used to define the tumor size, position, and its relevant complications while 3D-CTA was applied to define the blood supply of the tumor and the venous complex (VC) shift before operations. Most of the meningiomas had developed at both sides of the tentorial plane and extended laterally with typical characteristics of a pineal region tumor.ResultsAll tumors were completely removed surgically without any injury to the VC. Postoperative intracranial infection occurred in one case who recovered after antibiotics were given. Postoperative intraventricular hemorrhage and pneumocephalus were found in one case, but fully recovered after conservative treatment. In the nine cases of concurrent hydrocephalus, this was gradually relieved in eight patients and the single case that became aggravated was successfully treated with ventriculoperitoneal shunt. Moreover, the follow-up MRI examinations did not indicate any recurrence of the meningiomas.ConclusionWe found that the use of Poppen's approach is strongly supported for the successful removal of pineal region meningiomas without serious complications.

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Section: Discussionmentioning

confidence: 99%

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Zhao

Wang

et al. 2011

World J Surg Onc

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“…5 Hemorrhage from the tumor bed is unusual in cases of velum interpositum meningioma because the blood supply is derived from small choroidal branches that are easily controlled as the tumor is resected. Nevertheless, difficulty controlling intraoperative tumoral bleeding has been reported in four cases, 36,51,53 and one case of postoperative hemorrhage has been described. 46 Although engulfment and occlusion of portions of the deep venous system are more common in cases of falcotentorial meningiomas, one example of occlusion of the deep venous system has been reported in association with a velum interpositum meningioma.…”

Section: Potential Surgical Complicationsmentioning

confidence: 95%

“…19,24,25,28,36,40,43,46,51,53 Variable degrees of tumor blush were observed in nine cases. The PChAs supplied the tumor in all cases; in only one case was the medial PChA not visualized.…”

Section: Imaging Characteristicsmentioning

confidence: 97%

“…The PChAs supplied the tumor in all cases; in only one case was the medial PChA not visualized. 36 Although discrepancy of the direction of displacement between the plexal segment of the medial PChA and the internal cerebral veins is pathognomonic of a tumor originating within the velum interpositum, this sign is not reliable because meningiomas of the tela choroidea may displace both arteries and veins together either superiorly or inferiorly. 24 During the venous phase, lack of opacification of major deep veins may indicate that intraoperative sacrifice of the deep venous system might be tolerated.…”

Section: Imaging Characteristicsmentioning

confidence: 98%

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Meningiomas of the velum interpositum: surgical considerations

Lozier¹,

Bruce²

2003

FOC

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Meningiomas of the third ventricle are a rare subtype of pineal region tumor that arise from the posterior portion of the velum interpositum, the double layer of pia mater that forms the roof of the third ventricle. The authors review the literature concerning these meningiomas and present a case in which the lesion was resected via the supracerebellar–infratentorial approach. The relationship of the tumor to the deep venous system and the splenium of the corpus callosum guides the selection of the most advantageous surgical approach. Posterior displacement of the internal cerebral veins demonstrated on preoperative imaging provides a strong rationale for use of the supracerebellar–infratentorial approach.

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“…Arachnoid cysts [17,18], arteriovenous malformations [19] and meningiomas [20] and atypical teratoid/rhabdoid tumors [2] have been reported to develop inside VI. It is important to achieve a correct differential diagnosis with other CSF cystic formations.…”

Section: Discussionmentioning

confidence: 99%

Cavum Veli Interpositi: Just an Anatomical Variant or a Potentially Symptomatic CSF Compartmentalization?

Giussani

Fiori²,

Trezza³

et al. 2011

Pediatr Neurosurg

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Background: The cavum veli interpositi (CVI) usually is a small CSF-containing abnormality of septum pellucidum, asymptomatic and rare after the age of 3 years. When symptomatic, it is large and can be related to psychiatric disorders, syndromic association of mental retardation and seizures or to hydrocephalus. Methods: This is the first reported case of an otherwise healthy pediatric patient with a large CVI experiencing episodes of hypertonic loss of consciousness unrelated to epileptic, cardiologic or psychiatric causes without signs of chronic increase in intracranial pressure (ICP). Results: Supposing a CSF compartmentalization in the CVI as the cause of acute poussés of ICP due to block of CSF pathways and considering the severity of the symptoms, an endoscopic fenestration was performed with a reduction of cyst dimensions. Conclusion: We suggest considering the fenestration of large CVI even in otherwise asymptomatic patients to avoid the risk of CSF compartmentalization with ICP poussés.

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Successful removal of large pineal region meningiomas: two case reports

Cited by 14 publications

References 10 publications

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Use of 3D-computed tomography angiography for planning the surgical removal of pineal region meningiomas using Poppen's approach: a report of ten cases and a literature review

Meningiomas of the velum interpositum: surgical considerations

Cavum Veli Interpositi: Just an Anatomical Variant or a Potentially Symptomatic CSF Compartmentalization?

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