A rare case of falcotentorial meningioma type II of the pineal region

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Rahmad Mulyadi
Prijo Sidipratomo
Taufik Budianto
Eka Susanto


Background: Pineal region meningiomas are incredibly uncommon causes of pineal mass. Diagnosis is usually made when the tumours already reach huge diameters and cause mass effects, obstructing the ventricles and aquaducts.

Case Illustration: We present a case of a 32-year-old man complaining of worsening blurred visions and headaches. Brain Magnetic Resonance Imaging (MRI) disclosed a well-defined, lobulated pineal region mass that homogenously enhanced after contrast injection, with a dural adherence, close to the junction of the Vein of Galen and the straight sinus and inferior to the anterior edge of the tentorium, suggestive of a diagnosis of falcotentorial meningioma type II from the pineal region. The tumour compressed the mesencephalon and caused non-communicant hydrocephalus. The patient underwent tumour removal. Histological analysis of the tumour was consistent with meningioma WHO grade I.

Discussion : Pineal region meningioma, the falcotentorial type, can also be classified into four different types based on the tumour’s adherence to the dura and the extension to its surrounding structures. Although rare, pineal region meningioma should be included as a differential diagnosis in a patient presenting with a pineal mass. MRI, both conventional and multimodal, still holds a crucial role in aiding clinicians and surgeons to make the correct diagnosis and deliver the best treatment option for the patients.

Conclusion : MRI can help differentiate pineal region meningiomas from intracranial and other pineal region tumours and aid the neurosurgeons in deciding the appropriate management approach for this rare intracranial neoplasm.

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