Meningioma of the Falco-tentorial junction developing into the Pineal Region

Abstract

The authors report two cases of successfully removed meningioma of the free margin of the tentorium which had developed into the quadrigemino-pineal region. Case 1: A 45-year-old woman presented symptoms of headache, mental deterioration, urinary incontinence, and gait disturbance of 6 months' duration. Computed tomography (CT) demonstrated a round, homogeneously enhanced mass lesion in the pineal region associated with hydrocephalus. Magnetic resonance imaging (MRI) showed the tumor mostly extending down into the infratentorial space. A ventriculoperitoneal shunt operation was performed. The tumor was totally removed through the infratentorial supracerebellar approach (Stein's approach) with the Nd-YAG laser and an ultrasonic surgical aspirator. Case 2: A 59-year-old woman was admitted with headache, unsteady gait, hoarseness, and swallowing disturbance of 6 months' duration. CT revealed a round-shaped highdensity mass in the pineal region with homogeneous contrast enhancement. MRI showed the tumor occupying the posterior third ventricle and extending above and below the tentorium cerebelli. The tumor was totally resected through the occipital transtentorial approach (Jamieson's approach). The postoperative courses of these cases were uneventful and the patients were discharged with no neurological deficits. Similar cases reported in the literature are reviewed and the clinical features, diagnostic aspects, and surgical management are discussed.