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

Li, Yunqian; Zhao, Gang; Wang, Honglei; Zhu, Wanan; Qu, Limei; Li, Y e; Yu, Jinlu

doi:10.1186/1477-7819-9-64

Cited by 16 publications

(17 citation statements)

References 25 publications

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“…The role of melatonin in aging and Alzheimer's disease suggested by Wu YH et al 16 , the association of amount of brain sand and schizophrenia shown by Savel'ev et al 17 , the importance of pineal gland anatomy in the surgical management of pineal tumors 18 , all these signify the importance of updating data on pineal gland anatomy. In order to correlate the morphological and microscopic features of pineal gland with its secretory activity and physiological significance, investigations in the form of serum estimation of melatonin and immunohistochemical studies of enzymes in the pinealocytes are needed which could not be included in this work.…”

Section: Discussionmentioning

confidence: 98%

Age- and Sex- Related Changes in Pineal Gland: A Morphological and Histological Study

G¹

2015

AJIM

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Abstract:Introduction: Pineal gland is believed to be an endocrine gland, melatonin being the principal hormone secreted by it. Updating any knowledge about the anatomy of pineal gland will expand our understanding of pineal physiology and pathophysiology and of the possible medical use of pineal compounds. Materials and Methods: We conducted a cross-sectional observatory study in pineal gland specimens collected from human subjects during autopsy after obtaining written informed consent from relatives. Subjects died of malignancy or head injury were excluded from the study. Morphological and histological analysis was done after preservation. Results: There were 90 adult specimens and 12 fetal specimens. Mean (±SD) age, length of specimen, width, thickness (centimeters) and weight (grams) of specimen were 41.37 ± 23.3, 0.79 ± 0.17, 0.59 ± 0.13, 0.35 ± 0.10 and 0.08 ± 0.04 respectively. The average number of pinealocytes and glial cells per field were 184.6 ± 29.41 and 7.20 ± 2.65 respectively. Incomplete lobules were seen in 52 adult specimens and complete in 38. Calcification was observed in 69 specimens. Changes of pattern of lobule from incomplete to complete and increase in calcification were found to be significantly correlated with advancing age. Conclusion: Increasing calcification and change in lobular pattern are observed as advancing age related changes in present study. Estimation of melatonin and data regarding factors affecting these changes may be done further to identify its pathophysiological significance.

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Section: Discussionmentioning

confidence: 98%

Age- and Sex- Related Changes in Pineal Gland: A Morphological and Histological Study

G¹

2015

AJIM

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“…2,11 However, most pineal region meningiomas grow downward from the origin and are located below the falcotentorial junction, and they displace the galenic venous system downward. 10 Pineal region meningiomas, which originate near the falcotentorial junction, receive blood supply from the meningeal arteries along the tentorium and falx, and tend to grow in both infra-and supratentorial spaces with lateral extension.…”

Section: Discussionmentioning

confidence: 99%

“…For these reasons, the OTA is preferable in most cases, because of the access to the pineal region without sacrificing the bridging veins from the cerebellar tentorial surface, early devascularization of the feeding arteries along the tentorium and falx, and exposure of both the supra-and infratentorial spaces. 2,9,10,15,16 However, pineal region meningiomas, especially large ones, tend to be separated into 4 anatomical compartments by the cerebral falx, bilateral tentorium, and cerebellar falx. Furthermore, the straight sinus is located in the junction between the falx and tentorium and receives venous blood from the bilateral internal cerebral veins, vein of Galen, bilateral basal veins, and internal occipital veins.…”

Section: Discussionmentioning

confidence: 99%

Multistaged, multidirectional strategy for safe removal of large meningiomas in the pineal region

Otani¹,

Mori²,

Wada³

et al. 2018

Neurosurgical Focus

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OBJECTIVEPineal region meningiomas are rare and tend to be discovered only after they grow. Several simultaneous multidirectional approaches performed as a single operation have been proposed, but the best strategy to remove these deeply situated large meningiomas involving the deep vital venous system remains to be established. The authors advocate a multistaged, multidirectional approach to safely remove these challenging tumors.METHODSFour consecutive cases of meningioma in the pineal region were treated between April 2013 and June 2016. The 3 large (> 40 mm diameter) tumors were removed via multistaged, multidirectional approaches (2 surgeries in 2 patients and 3 surgeries in 1 patient) with gravity retraction of the occipital or parietal lobe. The large occipital skin incision extending bilaterally was used for the next operation from the contralateral side. Combinations of the occipital transtentorial approach with or without the transfalcine approach, occipital bitranstentorial/falcine approach, combined supra-/infratentorial transsinus approach, and contralateral parietal interhemispheric transcallosal approach were used.RESULTSTransient visual field deficits occurred after 2 of the 8 operations, but all tumors were removed grossly or subtotally without permanent surgery-related morbidity. The galenic venous system and straight sinus remained intact in all patients. During the follow-up period (mean 29.5 months [range 13–52 months]), there were no recurrences after the final operation.CONCLUSIONSA multistaged, multidirectional strategy with an intentional large occipital scalp incision and gravity retraction of the occipital lobe is a good choice for the safe removal of large meningiomas in the pineal region.

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“…In our experience, the images available from 3D-CTA have been useful for the sophisticated preoperative planning of the meningioma. 3D-CTA clearly shows the relationship between vessels and the tumor, and also enables the vessels to be protected from damage during surgery (17). …”

Section: Discussionmentioning

confidence: 99%

Clinical value of multi-slice 3-dimensional computed tomographic angiography in the preoperative assessment of meningioma

Jiang-shan

et al. 2013

Experimental and Therapeutic Medicine

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The aim of this study was to evaluate the clinical value of multislice 3-dimensional computed tomographic angiography (3D-CTA) in the preoperative assessment of meningiomas. A total of 331 cases with meningiomas confirmed by CT and MRI were examined using 3D-CTA. The locations of the tumors were observed to be as follows: parasagittal and falcine in 125 cases, sphenoidal in 39 cases, in the olfactory groove in 19 cases, tentorial in 21 cases, parasellar in 33 cases, petroclival in 29 cases, intraventricular in 7 cases and on the convexity of the brain in 58 cases. The reconstructed images were processed by shaded volume rendering, maximum intensity projection and color-shaded surface display. The 3D-CTA images were used to imitate the surgical approach. Surgery was performed according to the information provided in the 3D-CTA images. 3D-CTA provided clear 3D images of the meningioma and the relationship with the adjacent vessels and the skull base, and demonstrated the optimal surgical approach for removing the neoplasm. The results of 3D-CTA corresponded extremely well with the surgical observations. 3D-CTA is able to provide 3D images of the meningioma, adjacent vessels and the bones in the skull base. Furthermore, 3D-CTA supplies information vital in the selection of the optimal surgical approach and information that aids the management of the sinus during the surgery. 3D-CTA is of great value in the preoperative evaluation of meningiomas.

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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

Cited by 16 publications

References 25 publications

Age- and Sex- Related Changes in Pineal Gland: A Morphological and Histological Study

Age- and Sex- Related Changes in Pineal Gland: A Morphological and Histological Study

Multistaged, multidirectional strategy for safe removal of large meningiomas in the pineal region

Clinical value of multi-slice 3-dimensional computed tomographic angiography in the preoperative assessment of meningioma

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