Abstrakt
The pineal region is a deep-seated area of the brain surrounded by eloquent structures. Differential diagnosis of space-occupying lesions in this region encompasses pineal gland cysts, pineal gland tumors, metastases, germ cell tumors, meningiomas, gliomas, ependymomas, hemangioblastomas, and neuroectodermal tumors.
Cavernomas are also rather frequent lesions in this area; more rare lesions include arteriovenous malformations, and cholesteatomas occur infrequently. The surgical strategy is mainly based on anatomical characteristics and the histological type of the tumor.
Except for radiosensitive germinomas, complete surgical excision is the treatment of choice.Microsurgical supracerebellar-infratentorial (SCIT) approach is essential for resection of pineal region lesions. SCIT is a straightforward extracerebral approach via the natural corridor between the superior aspect of the cerebellum and the tentorium.
A unilateral SCIT approach has recently been used to protect the dominant transverse sinus and spare the bridging veins between the vermis and tentorium. The SCIT is a versatile approach, addressing not only lesions in the pineal region but also pathologies in the tectum and lateral mesencephalon, posterior third ventricle, upper fourth ventricle, anterior rectus sinus, posterior thalamus and upper cerebellopontine angle, medial temporal and occipital lobe, and finally, the petroclival area up to the posterior clinoid process.
The cavum Meckeli is also accessible.