title: Successful removal of large pineal region meningiomas: two case reports.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Neurological Surgery, Queen Elizabeth Medical Center, Birmingham, England.
authors.forename: C L
authors.initials: CL
authors.lastname: Mallucci
authors.forename: S
authors.initials: S
authors.lastname: Obukhov
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008579:Meningioma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D010870:Pineal Gland / Q000473:pathology / Q000601:surgery*; D014057:Tomography, X-Ray Computed