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.
Highlights
Meningiomas of the pineal region are rare, accounting for approximately 8% of tumors in this region [1, 2]
This study presents a combined microscopic and endoscopic surgery using the occipital-parietal transtentorial approach for the radical resection of pineal region meningiomas
Total resection was believed to have been achieved in four patients, but the residual tumor was detected after endoscopic exploration and was completely resected using an endoscope
Summary
Meningiomas of the pineal region are rare, accounting for approximately 8% of tumors in this region [1, 2]. Visualization of the surgical field without blind spots is changing using these approaches because the tumor is obscured by the dural structures and deep venous system [7,8,9]. Previous studies have reported various modifications to overcome these disadvantages, including the occipital bitranstentorial/falcine approach, bilateral occipital craniotomy, and simultaneous combined supratentorial/ infratentorial approaches [10,11,12]. These approaches provide a wider exposure but are associated with significant risks, such as venous infarction and cortical blindness
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