SUCCESSFUL REMOVAL OF LARGE PINEAL REGION MENINGIOMAS - 2 CASE-REPORTS

BACKGROUND Pineal region meningiomas are extremely rare tumors and com prise about 8% of tumors of this region. Two cases of large pineal reg ion meningiomas in young males are presented. METHODS Computed tomogra phy (CT) scan and cerebral angiography were used to evaluate the patie nts preoperatively. Both patients were operated on through an occipita l transtentorial approach either as a single- or two-stage procedure. RESULTS Preoperative work-up revealed that both tumors received their main blood supply from the posterior lateral choroidal arteries and we re therefore originating from the velum interpositum cerebri (superior tela choroidea). Complete tumor removal was effected in the first pat ient using a right occipital transtentorial approach. In the second pa tient, after partial removal using the same approach, complete resecti on was achieved at a second stage via the left occipital transtentoria l approach 3 months later. CONCLUSION Cerebral angiography, which must include vertebral angiography, is important in the preoperative surgi cal planning of these tumors. The occipital transtentorial approach pr ovides good access. However, a two-stage procedure using right and lef t sides may be necessary for large meningiomas receiving a bilateral b lood supply from both posterior lateral choroidal arteries. Diagnosis, the surgical approach, and methods of tumor excision are discussed.