PINEAL REGION MENINGIOMA

Pineal Region Meningioma

Pineal region Meningioma is a deep tumor tucked in between the infra-tentorial and supra-tentorial compartments in the intracranial space. The tumor is behind the pineal gland, in the backside of the upper part of the brainstem, called the quadrigeminal plate, which controls eye coordination. It tends to press upon this part of the brainstem causing obstruction of the cerebral-spinal fluid (CSF) and enlargement of the CSF brain chambers (hydrocephalus).

Symptoms

Patients with pineal region Meningiomas present with headache, balance or gait difficulties, and vision changes. Patients with associated hydrocephalus can develop cognitive dysfunction or acute mental status change. Patients with hydrocephalus may need emergency intervention to alleviate intracranial pressure before tumor resection.

Treatment

Symptomatic pineal region Meningiomas, in general, need surgical intervention. Smaller tumors may be treated primarily with CiberKnife radiation therapy or Proton bean Radiation Therapy. Incidental tumors in elderly patients may be managed with observation with surveillance MRIs.

Surgical Treatment at the Meningioma Center

Pineal region Meningiomas are approached through a focused small midline or para-midline craniotomy in the back of the head. This focused approach allows navigation over the cerebellum and resection of parts of the tentorium for directly accessing the tumor in the infra and supratentorial compartments. This approach avoids exposure and retraction or manipulation of the occipital lobe of the brain which is responsible for the perception of vision. Furthermore, this focused approach enhances the potential for maximal resection of the tumor with function preservation.

Prognosis

Treatment of pineal region Meningiomas through a focused combined sub-occipital craniotomy approach improves chances of maximal tumor removal with function preservation or recovery of function, including, pre-operative visual difficulties, cognitive dysfunction, and gait/balance problems. Adequate Treatment of pineal region Meningiomas enhances the potential for patients to return to their lifestyle and job occupation. Maximal removal of the tumor and its meningeal root maximizes the chances of the patient progressing without tumor recurrence.