Cavernous Malformations of the Pineal Region: Overview, Management, and Controversies

Cavernous malformations (CMs) of the brain represent low-flow vascular lesions comprised of dilated sinusoid blood vessels with thin walls, containing blood or clots in various stages of degradation. They are mostly congenital in nature, but acquired CMs have been reported, for instance, after radiotherapy. Frequently, they are discovered incidentally, and a significant number of these lesions can remain clinically silent over a long period of time. Depending on the exact location within the brain, CMs may cause epilepsy, headache, focal neurological deficit, and hemorrhagic stroke. Owing to the proximity of the pineal region to the sylvian aqueduct, a hemorrhagic presentation from a cavernoma in this location may lead to acute obstructive hydrocephalus, loss of consciousness, and, on very rare occasions, even to death. Only a small number of pineal region CMs have been described in the literature. In this chapter, we provide a short overview of pineal region CMs and their surgical management, and discuss the controversies regarding their treatment.