Abstract
Background: Pineal region tumors are uncommon and encompass a histologically diverse group of lesions. Meningiomas arising from the falcotentorial region and presenting as pineal masses are rare, accounting for a small proportion of intracranial meningiomas. Their deep-seated location and close relationship with critical neurovascular structures pose significant surgical challenges. We report a large falcotentorial meningioma of the pineal region highlighting operative considerations and clinical outcome.
Case presentation: A 50-year-old female presented with progressive headache, vomiting, visual disturbances, and features of Parinaud’s syndrome. Magnetic resonance imaging demonstrated a well-defined, homogeneously enhancing pineal region mass measuring 5.3 × 4.5 × 4.2 cm, causing obstructive hydrocephalus and displacement of deep venous structures. Serum and cerebrospinal fluid tumor markers were negative. Following ventriculoperitoneal shunt placement, the patient underwent gross total excision via an interhemispheric approach. Intraoperatively, the tumor was soft, vascular, and attached to the falx cerebri and tentorium cerebelli. Postoperative imaging demonstrated satisfactory decompression without definite residual enhancing lesion. Histopathological examination confirmed a World Health Organization Grade I transitional meningioma. The postoperative course was uneventful, and the patient remained neurologically stable on follow-up.
Conclusions: Large falcotentorial meningiomas presenting as pineal region masses are uncommon and technically demanding due to their anatomical proximity to the quadrigeminal plate and deep venous system. Careful preoperative evaluation and meticulous microsurgical technique enable safe resection with favorable outcomes.
