Matsuda Y, Inagawa T
Department of Neurosurgery, Shimane Prefectural Central Hospital, Japan.
Neurol Med Chir (Tokyo). 1995 Aug;35(8):594-7. doi: 10.2176/nmc.35.594.
Three patients with large or huge meningiomas of the pineal region presented with headache, vomiting, gait and visual disturbance, apraxia, agnosia, and transient amnestic aphasia. Computed tomographic scans revealed round, high-density areas of 8 x 7 x 7 cm, 5 x 5 x 4 cm, and 3 x 3 x 3 cm in the pineal region. Angiography revealed that the bilateral internal cerebral veins and the great vein of Galen were stretched and significantly displaced upward in one patient, and downwards in the other two. The meningiomas appeared to originate from the verum interpositum and falcotentorial junction, respectively. The tumors were removed subtotally or totally via an occipital interhemispheric transtentorial approach and/or infratentorial supracerebellar approach. The postoperative courses were uneventful, and no neurological deficit was detected postoperatively. Pineal region tumors with a maximum diameter of 5 cm or larger should be operated on via a unilateral or bilateral occipital interhemispheric transtentorial approach, regardless of the angiographic findings, because this permits a wide operative field and can be followed, if necessary, by an infratentorial supracerebellar approach. Selection of the operative approach for a relatively small pineal region tumor should depend on the angiographic findings: downward displacement of the bilateral internal cerebral veins and the great vein of Galen indicates an occipital interhemispheric transtentorial approach, whereas upward displacement indicates an infratentorial supracerebellar approach.
3例松果体区大型或巨大脑膜瘤患者表现为头痛、呕吐、步态及视觉障碍、失用症、失认症和短暂性遗忘性失语。计算机断层扫描显示松果体区有8×7×7cm、5×5×4cm和3×3×3cm的圆形高密度区。血管造影显示，1例患者双侧大脑内静脉和大脑大静脉被拉伸并明显向上移位，另外2例则向下移位。脑膜瘤似乎分别起源于中间帆和小脑幕镰状联合。通过枕叶半球间经小脑幕入路和/或幕下小脑上入路将肿瘤部分或全部切除。术后病程平稳，术后未发现神经功能缺损。松果体区最大直径5cm或更大的肿瘤，无论血管造影结果如何，均应通过单侧或双侧枕叶半球间经小脑幕入路进行手术，因为这样可提供广阔的手术视野，必要时可继以幕下小脑上入路。对于相对较小的松果体区肿瘤，手术入路的选择应取决于血管造影结果：双侧大脑内静脉和大脑大静脉向下移位表明采用枕叶半球间经小脑幕入路，而向上移位则表明采用幕下小脑上入路。
