Mallucci C L, Obukhov S
Department of Neurological Surgery, Queen Elizabeth Medical Center, Birmingham, England.
Surg Neurol. 1995 Dec;44(6):562-6. doi: 10.1016/0090-3019(95)00220-0.
Pineal region meningiomas are extremely rare tumors and comprise about 8% of tumors of this region. Two cases of large pineal region meningiomas in young males are presented.
Computed tomography (CT) scan and cerebral angiography were used to evaluate the patients preoperatively. Both patients were operated on through an occipital transtentorial approach either as a single- or two-stage procedure.
Preoperative work-up revealed that both tumors received their main blood supply from the posterior lateral choroidal arteries and were therefore originating from the velum interpositum cerebri (superior tela choroidea). Complete tumor removal was effected in the first patient using a right occipital transtentorial approach. In the second patient, after partial removal using the same approach, complete resection was achieved at a second stage via the left occipital transtentorial approach 3 months later.
Cerebral angiography, which must include vertebral angiography, is important in the preoperative surgical planning of these tumors. The occipital transtentorial approach provides good access. However, a two-stage procedure using right and left sides may be necessary for large meningiomas receiving a bilateral blood supply from both posterior lateral choroidal arteries. Diagnosis, the surgical approach, and methods of tumor excision are discussed.
松果体区脑膜瘤极为罕见，约占该区域肿瘤的8%。本文报告两例年轻男性的大型松果体区脑膜瘤病例。
术前采用计算机断层扫描（CT）和脑血管造影对患者进行评估。两名患者均通过枕下经小脑幕入路进行手术，手术可分为一期或二期进行。
术前检查显示，两个肿瘤的主要血供均来自脉络膜后外侧动脉，因此起源于大脑间帆（脉络膜上 tela choroidea）。首例患者采用右枕下经小脑幕入路实现了肿瘤全切。第二例患者在采用相同入路部分切除肿瘤后，3个月后通过左枕下经小脑幕入路二期实现了肿瘤全切。
脑血管造影（必须包括椎动脉造影）在这些肿瘤的术前手术规划中很重要。枕下经小脑幕入路提供了良好的手术入路。然而，对于接受双侧脉络膜后外侧动脉双侧血供的大型脑膜瘤，可能需要分左右两侧进行两期手术。本文讨论了诊断、手术入路和肿瘤切除方法。
