Supracerebellar-infratentorial approach to pineal tumor. | Figure 1

AlfredoDaniel

Neurosurgery

Supracerebellar-infratentorial approach to pineal tumor

Similar cases

Axial FLAIR (image 1) and sagittal T1 FLAIR MRI images show a hypothalamic hamartoma (arrow). Patients with these lesions classically present with gelastic or laughing seizures. Hypothalamic hamartomas may also cause symptoms such as precocious puberty or behavioral and cognitive difficulties. On imaging, hypothalamic hamartomas are isointense to gray matter on T1-weighted images and hyperintense on T2-weighted images, without enhancement after contrast administration.](https://app.figure1.com/case-detail/04bb4529-3517-4a0b-b800-ff5f349700ff)

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Final path, #Meningioma . Based on history of signs/symptoms (HA, weakness on right, etc) , likely present at least 18 months before presentation/surgery with profound weakness right UE and LE](https://app.figure1.com/case-detail/256deb0a-f467-4fff-bec2-7b1557be094d)

Image description
Axial T2-weighted (image 1), sagittal T1-weighted (image 2), and sagittal postcontrast T1-weighted (image 3) MRI show a large posterior fossa mass (arrow). The mass has an irregular margin with small internal cystic spaces and demonstrates homogeneous enhancement. There is compression of the adjacent medulla and obstruction of the fourth ventricle.

Teaching point
Clear cell meningioma is an uncommon histologic subtype of meningioma and is classified as CNS WHO grade 2. In children and young adults, it more frequently involves the posterior fossa and spinal canal than typical meningiomas. Imaging findings, including homogeneous enhancement and occasional internal cystic spaces, are not specific and do not reliably distinguish this entity from other meningioma subtypes or posterior fossa tumors. The diagnosis is defined histologically by sheets of glycogen-rich clear cells, and the grade 2 designation reflects a higher risk of local recurrence based on clinical behavior rather than imaging appearance.](https://app.figure1.com/case-detail/3c135f38-3da2-4def-85f6-a994e36da55d)