PMC7568112_01
(a) Preoperative axial T1 ponderation - bleeding centered in the region of quadrigeminal lamina/pineal region associated with small round heterogeneous on his left anterior aspect with triventricular hydrocephalus, (b) axial FLAIR showing active hydrocephalus with ependimary transudation, (c) sagittal T1 gadolinium showing pineal lesion with Sylvius aqueduct obstruction, (d) T2 coronal showing pineal lesion with consequent hydrocephalus, the core of the lesion is surrounded by a halo of lower intensity due to hemosiderin.
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F1
This examination showed a lesion in the pineal region and triventricular hydrocephalus, as described in Figure 1.
(a) Axial T1 2 months after endoscopic ventriculostomy and total excision of the lesion of the pineal region, (b) axial FLAIR showing nondilated temporal horns, (c) T1 sagittal showing repermeability of Sylvius aqueduct, and (d) T2 coronal showing a small blood residue, no mass effect and without hydrocephalus signals.
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F2
She later underwent suboccipital craniotomy and total excision of the lesion by the infratentorial supracerebellar approach a few days after [Figure 2].
(a) Hematoxylin-eosin shows an agglomerate of vessels of different sizes and thin walls, (b) hematoxylin-eosin shows vessels surrounded blood and histiocytic infiltrate with hemosiderin pigment, (c) hematoxylin-eosin with signs of old hemorrhage, and (d) Verhoeff coloration showing elastic fibers in black.
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F3
Glial tissue fragments with recent hemorrhage, dilated sinusoidal channels, and infiltration by histiocytes containing hemosiderin confirmed the suspicious diagnosis considering the MR characteristic of pineal cavernous malformation [Figure 3].