Pineal cavernous malformations: report of two cases.
Pineal hemorrhage only occurs in rare cases, and this known to have several different causes such as germ cell tumors, pineal cysts and vascular malformations, including the cavernous malformations. Pineal cavernous malformations are extremely rare: to date only fifteen cases have been reported worldwide. Although the diagnosis of pineal cavernous malformation is not easy because of the extreme rareness of this condition, the presence of this lesion can be suspected based on its typical radiological findings. Case 1. A 42-year- old man presented with a limitation in his upward gazing. Radiologic examinations showed acute hemorrhage in the pineal region. He underwent ventriculo-peritoneal (VP) shunting but the patient's condition deteriorated after the shunting surgery. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. Case 2. A 37-year-old man presented with diplopia. Radiologic examinations showed acute hemorrhage in the third ventricle. He underwent VP shunting, and after this procedure the diplopia was aggravated. We operated and totally removed the tumor and the hemorrhages via an occipital-transtentorial approach. If there is no doubt about the pineal cavernous malformation on MR imaging, we strongly recommend early surgical intervention without performing a risky biopsy. In this study, we describe our experiences for the diagnosis of cavernous malformations in the pineal region with special emphasis on the radiological aspects and the clinical course of this disease.
Kim
Dong-Seok
DS
Department of Neurosurgery, Yonsei University College of Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul 120-752, Korea.
Shim
Kyu-Won
KW
Kim
Tae-Gon
TG
Chang
Jong-Hee
JH
Park
Yong-Gou
YG
Choi
Joong-Uhn
JU
D000328:Adult; D000792:Angiography; D020785:Central Nervous System Vascular Malformations / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D004172:Diplopia / Q000175:diagnosis; D006406:Hematoma / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D020300:Intracranial Hemorrhages / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D010870:Pineal Gland / Q000098:blood supply; D014057:Tomography, X-Ray Computed