Supracerebellar Infratentorial Approach for a Malignant Pineal Region Tumor Mimicking a Cavernous Malformation

A man in his early 20s presented with diplopia. Imaging revealed a pineal region hemorrhagic lesion, suggestive of cavernous malformation.^1-6 The patient underwent an endoscopic third ventriculostomy and was transferred to our institution. In the sitting position, he underwent a supracerebellar infratentorial approach. Gross total resection was achieved without new neurological deficits. Pathologic diagnosis was consistent with a mixed germ cell tumor. The patient was referred to the radiation oncology department. Gravity retraction of the cerebellum was achieved with the supracerebellar infratentorial approach in the sitting position, torcular craniotomy exposed the major sinuses, and drainage of cerebrospinal fluid widened the surgical corridor and facilitated resection of this lesion (Video 1). Histopathological findings are critical to establish the correct diagnosis because magnetic resonance imaging findings can be misleading. The patient provided written informed consent for the procedure.