====== Vascular pineal malformation ======

===== Differential diagnosis =====
It is very important to perform the [[differential diagnosis]] in such cases because [[pineal hemorrhage]] is very rare and it may be associated with many different causes. The possible causes of pineal hemorrhages are [[pineal region tumor]]s
((Hung YC, Lee EJ, Wang LC, Chen HH, Yan JJ, Yu CY. Mixed germ cell tumor presenting as intratumoral hemorrhage: report of a case originated from the pineal region. Kaohsiung J Med Sci. 1999;15:498–503.))
((Maruki C, Takara K, Abe K, Tsunoda A, Ebato M, Ikeya F. Primary pineal embryonal carcinoma occurring in a middle aged man. No Shinkei Geka. 2000;28:909–912. Japanese.))
((Nogueira K, Liberman B, Pimentel-Filho FR, Goldman J, Silva ME, Vieira JO, et al. hCG-secreting pineal teratoma causing precocious puberty: report of two patients and review of the literature. J Pediatr Endocrinol Metab. 2002;15:1195–1201.))
((Sakurada K, Kayama T, Kawakami K, Saino M, Sato S. A successfully operated case of choriocarcinoma with recurrent intratumoral hemorrhage. No Shinkei Geka. 2000;28:67–72. Japanese.))
((Kida Y, Banno M, Kanzaki M, Kobayashi T, Kageyama N. Pineal choriocarcinoma presenting massive ventricular hemorrhage--a case report. No Shinkei Geka. 1985;13:641–645. Japanese.))
((Wakai S, Yamakawa K, Manaka S, Takakura K. Spontaneous intracranial hemorrhage caused by brain tumor: its incidence and clinical significance. Neurosurgery. 1982;10:437–444.))
((Fujii T, Itakura T, Hayashi S, Komai N, Nakamine H, Saito K. Primary pineal choriocarcinoma with hemorrhage monitored by computerized tomography. Case report. J Neurosurg. 1981;55:484–487.)).

[[Vascular]] [[pineal]] [[malformation]]s are rare, and technically demanding [[lesion]]s. Due to their location, [[endovascular]] [[technique]]s and [[radiosurgery]] have been increasingly used to accomplish a safe occlusion. Nevertheless, sometimes, [[microsurgical resection]] may be required.

Choque-Velasquez et al., present a retrospective review of the vascular pineal malformations operated by the senior author. Moreover, they report [[illustrative]] [[case]]s for the various types of vascular lesions with a careful analysis of the different microsurgical stages.

Eighteen patients with pineal vascular lesions were operated on between 1980 and 2015: 6 patients had vein of Galen malformations, 5 plexiform arteriovenous malformations, 6 [[pineal cavernous malformation]]s, and one patient had a ruptured medial posterior choroidal artery aneurysm. A complete resection/occlusion was possible in all vascular malformations.

The pineal region is an infrequent but challenging location for vascular lesions. A careful and stepwise operative strategy for the different types of vascular lesion is paramount to accomplish an effective and safe microsurgical treatment, when other alternatives fail or are not available
((Choque-Velasquez J, Resendiz-Nieves J, Colasanti R, Collan J, Hernesniemi J.
Microsurgical management of vascular malformations of the pineal region. World
Neurosurg. 2018 Jun 23. pii: S1878-8750(18)31326-3. doi:
10.1016/j.wneu.2018.06.110. [Epub ahead of print] PubMed PMID: 29945013.
)).