Abstract
BackgroundWe present two rare cases of pineal-region meningiomas. These tumors are the first reported cases of dura-unrelated meningiomas originating from the arachnoid membrane over the vein of Galen (AMG).Case descriptionIn Case 1, a 37-year-old woman presented with a progressing headache. Magnetic resonance imaging (MRI) showed a large tumor in the pineal region, displacing the vein of Galen upward. Angiography disclosed occlusion of the vein of Galen, with deep venous flow draining through the veins on the right medial surface of the occipital lobe to the superior sagittal sinus. In Case 2, a 67-year-old man presented with dizziness. MRI demonstrated a large mass in the pineal region, displacing the vein of Galen inferiorly. Angiography disclosed occlusion of the vein of Galen, with deep venous flow draining through the collateral venous channel into the transverse sinus. Both tumors were totally excised (Simpson Grade III for Case 1, Grade I for Case 2) via a left occipital transtentorial approach. No dural attachment was recognized in either case, but the tumor in Case 1 was firmly adherent to the inferior portion of the AMG, while that in Case 2 was attached to the superior portion of the AMG, but remained dissectible.ConclusionsWe reported two cases of pineal-region meningiomas originating from the arachnoid membrane over the vein of Galen, resulting in meningioma without dural attachment. These tumors can be totally resected by careful dissection of the tumor from the arachnoid membrane surrounding the vein of Galen.
Highlights
We present two rare cases of pineal-region meningiomas
We reported two cases of pineal-region meningiomas originating from the arachnoid membrane over the vein of Galen, resulting in meningioma without dural attachment
These tumors can be totally resected by careful dissection of the tumor from the arachnoid membrane surrounding the vein of Galen
Summary
We have reported two uncommon cases of pineal-region meningioma in which the origin was thought to be arachnoid cells in the arachnoid membrane over the vein of Galen. We demonstrated that the arachnoid membrane over the vein of Galen has a different nature at the upper and lower sides. Among pineal-region meningiomas, we reported that tumors can derive from the arachnoid membrane of the vein of Galen and that these tumors are completely resectable by understanding the anatomy and nature of the arachnoid membranes in the quadrigeminal cistern. Consent Written informed consent was obtained from the patients for publication of this case report and any accompanying images. TO, YM, and RK drafted the manuscript. All authors read and approved the final manuscript
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