Abstract
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.
Highlights
There are several treatment approaches for pineal region meningiomas, such as Poppen’s approach, Krause’s approach and combinations of the two approaches
The findings of this study suggested that preoperative Computed tomography angiography (CTA) can greatly aid in the understanding of the anatomical relationship between the deep venous system and the tumor and its blood supply
Intraoperative results Out of the ten cases whose meningiomas were removed, six cases originated from the pineal region and four cases originated from the dura of the origin of straight sinus
Summary
There are several treatment approaches for pineal region meningiomas, such as Poppen’s approach, Krause’s approach and combinations of the two approaches. Recent reports of surgical interventions in the pineal region for meningiomas are mostly gained from independent studies that describe surgical approaches, such as Poppen’s approach, Krause’s approach and combinations of the two approaches. It can be very difficult for clinicians to choose the most appropriate treatment approach [2,4,5]. This study demonstrates that Poppen’s approach is clinically feasible for the treatment of meningiomas within the pineal region, and it provides a good prognosis for patients
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