title: Two cases of pineal-region meningiomas derived from arachnoid membrane over the vein of Galen without dural attachment.
abstract: BACKGROUND
  We present two rare cases of pineal-region meningiomas. These tumors are the first reported cases of dura-unrelated meningiomas originating from the arachnoid membrane over the vein of Galen (AMG).
  
  
  METHODS
  In Case 1, a 37-year-old woman presented with a progressing headache. Magnetic resonance imaging (MRI) showed a large tumor in the pineal region, displacing the vein of Galen upward. Angiography disclosed occlusion of the vein of Galen, with deep venous flow draining through the veins on the right medial surface of the occipital lobe to the superior sagittal sinus. In Case 2, a 67-year-old man presented with dizziness. MRI demonstrated a large mass in the pineal region, displacing the vein of Galen inferiorly. Angiography disclosed occlusion of the vein of Galen, with deep venous flow draining through the collateral venous channel into the transverse sinus. Both tumors were totally excised (Simpson Grade III for Case 1, Grade I for Case 2) via a left occipital transtentorial approach. No dural attachment was recognized in either case, but the tumor in Case 1 was firmly adherent to the inferior portion of the AMG, while that in Case 2 was attached to the superior portion of the AMG, but remained dissectible.
  
  
  CONCLUSIONS
  We reported two cases of pineal-region meningiomas originating from the arachnoid membrane over the vein of Galen, resulting in meningioma without dural attachment. These tumors can be totally resected by careful dissection of the tumor from the arachnoid membrane surrounding the vein of Galen.
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. iakihiro3@gmail.com.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Inoue
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. tohnishi@m.ehime-u.ac.jp.
authors.forename: Takanori
authors.initials: T
authors.lastname: Ohnishi
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. kouno@m.ehime-u.ac.jp.
authors.forename: Shohei
authors.initials: S
authors.lastname: Kohno
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. y.ohtsuka0818@gmail.com.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ohtsuka
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. aikians11@yahoo.co.jp.
authors.forename: Yawara
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. myousuke@m.ehime-u.ac.jp.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Mizuno
authors.affiliation: Division of Diagnostic Pathology, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. riko@m.ehime-u.ac.jp.
authors.forename: Riko
authors.initials: R
authors.lastname: Kitazawa
authors.affiliation: Department of Neurosurgery, Ehime University School of Medicine, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan. sohue@m.ehime-u.ac.jp.
authors.forename: Shiro
authors.initials: S
authors.lastname: Ohue
mesh_terms: D000328:Adult; D000368:Aged; D001099:Arachnoid / Q000473:pathology* / Q000601:surgery; D002550:Cerebral Veins / Q000473:pathology* / Q000601:surgery; D004388:Dura Mater / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology* / Q000601:surgery; D008579:Meningioma / Q000473:pathology* / Q000601:surgery; D010870:Pineal Gland / Q000473:pathology* / Q000601:surgery; D011379:Prognosis