Falcotentorial and velum interpositum meningiomas: Two distinct entities of the pineal region

Abstract

Objective

Among pineal region lesions meningiomas are extremely rare and include falcotentorial and velum interpositum meningiomas. It is very difficult to discriminate between these two lesions and description of the clinical presentation and the surgical technique in approaching these tumors is limited. We respectively analyzed a series of patients harboring pineal region meningiomas with regard to clinical features, neuroimaging studies, and results of surgical treatment.

Methods

Clinical data of 5 women and 1 man with pineal region meningiomas treated between January 1993 and December 2012 were retrospectively reviewed. All patients were assessed preoperatively with MRI and cerebral angiography. The only surgical approach we used was occipital transtentorial route.

Results

There were four falcotentorial and two velum interpositum meningiomas. The main presenting symptom was headache, dizziness and gait disturbance. The angiogram revealed that these tumors were fed by tentorial artery, posterior choroidal arteries, and branches of the posterior cerebral artery and in four cases additional evidence of occlusion of the galenic venous system was seen. Two patients had total resection (Simpson Grade I and Grade II) and in four patients small remnants of tumor were left (Simpson Grade III). No death occurred in this series. The most common complication after surgery was homonymous hemianopsia which fully recovered in all patients in the follow-up.

Conclusion

The falcotentorial and velum interpositum meningiomas can be safely managed with the use of occipital transtentorial approach. Homonymous hemianopsia is the most common although always transient complication of surgery.