The Transcallosal Approach to Pineal Region Lesions

2020 ◽  
pp. 91-99
Author(s):  
Krešimir Rotim ◽  
Tomislav Sajko
Keyword(s):  
Pineal Region ◽  
Transcallosal Approach

scholarly journals Interhemispheric transcallosal intervenous approach to a pineal region tumor

2021 ◽  
Vol 5 (1) ◽  
pp. V11
Author(s):  
Daniel A. Donoho ◽  
Guillermo Aldave
Keyword(s):  
Extent Of Resection ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Surgical Morbidity ◽  
Pineal Tumors ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Transcallosal Approach ◽  
Formidable Challenge ◽  
The Right

Pineal region tumors represent a formidable challenge to the neurosurgeon. Choosing the right approach is key to optimizing the extent of resection and minimizing surgical morbidity. In this video, the authors show an interhemispheric transcallosal approach to a pineal region tumor in a 15-year-old boy. The advantage of this corridor over posterior approaches is that it provides a nice view of the tumor plane with the venous complex, especially while dissecting tumor from the anterior aspect of the internal cerebral veins on their vertical path. Thus, this approach represents a safe and effective alternative for selected pineal tumors. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2120.

Posterior transcallosal intervenous-interforniceal approach to a periaqueductal tumor

2019 ◽  
Vol 1 (2) ◽  
pp. V8
Author(s):  
David S. Hersh ◽  
Katherine N. Sanford ◽  
Frederick A. Boop
Keyword(s):  
Pilocytic Astrocytoma ◽  
Third Ventricle ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Transcallosal Approach ◽  
Link Type ◽  
Risk Of Injury ◽  
Internal Cerebral Veins ◽  
Natural Separation ◽  
Periaqueductal Tumor

Described by Dandy in 1921, the posterior interhemispheric transcallosal approach provides an operative corridor to the pineal region, posterior third ventricle, and upper midbrain. Intervenous-interforniceal and paravenous-interforniceal variants have been utilized for midline and paramidline pathology, respectively. The intervenous-interforniceal variant capitalizes on the natural separation of the internal cerebral veins, which are found medial to the forniceal crura at this level, to provide a safe corridor to the tumor while minimizing the risk of injury to the fornices. Here, the authors describe a posterior interhemispheric transcallosal approach using the intervenous-interforniceal variant for resection of a periaqueductal pilocytic astrocytoma.The video can be found here: https://youtu.be/mtQKEXEveTg.

Posterior Interhemispheric Transcallosal Approach to Pineal Region Tumors

2008 ◽  
Vol 1 (4) ◽  
pp. A355-A355
Author(s):  
R. G. Ellenbogen ◽  
A. Avellino ◽  
K. Stevenson ◽  
P. Gabikian ◽  
R. Sze
Keyword(s):  
Pineal Region ◽  
Pineal Region Tumors ◽  
Transcallosal Approach

scholarly journals Surgical approaches to the third ventricle of the brain in children

2021 ◽  
Vol 11 (1) ◽  
pp. 47-54
Author(s):  
Sergey K. Gorelyshev ◽  
Olga A. Medvedeva
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Anterior Horn ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Lateral Ventricles ◽  
The Brain

AIM: This study aimed to describe and analyze the advantages and disadvantages of various surgical approaches to neoplasms of the third ventricle of the brain in children. MATERIALS AND METHODS: This study analyzed surgical interventions to the third ventricle in 657 patients, performed at the Academician N.N. Burdenko of the Research Institute of Neurosurgery from 1998 to 2018. These included 375 patients with intra-extraventricular craniopharyngiomas and 282 patients with gliomas of the third ventricle and chiasm. The patients age ranged from 3 mon to 18 years old. RESULTS: The anterior transcallosal approach provides access to the anterior horn and bodies of the lateral ventricles, as well as the third ventricle. The transfornical approach provides more opportunities for access to both the anterior and posterior parts of the third ventricle; however, it has a high risk of trauma to the fornix. The subchoroidal approach provides a very good view of the posterior parts of the third ventricle, especially of the pineal region; however, it has even greater restrictions on viewing its anterior parts. When compared with the transcallosal approach, the transfrontal approach can be used more safely in the absence of hydrocephalus (if the tumor is located in the anterior horn). No specific complications were inherent in a particular approach (seizures were registered in 1%, transient hemiparesis was noted in 10%, and transient memory impairments were revealed in 5% of cases). CONCLUSION: The use of a transcallosal approach is safe even in infants. The transcortical approach is recommended mainly for large tumors of the lateral ventricles, and the transcallosal approach should be used for small tumors of the third ventricle. No specific complications were inherent in a particular approach, and the choice was determined by the assessment of the exact location of the tumor and calculation of the most relevant trajectory for its achievement as well as the aim (biopsy or radical removal). Analysis of magnetic resonance imaging and neuronavigation are significant in the selection of surgical approaches.

scholarly journals Multistaged, multidirectional strategy for safe removal of large meningiomas in the pineal region

2018 ◽  
Vol 44 (4) ◽  
pp. E13 ◽  
Author(s):  
Naoki Otani ◽  
Kentaro Mori ◽  
Kojiro Wada ◽  
Arata Tomiyama ◽  
Terushige Toyooka ◽  
...  
Keyword(s):  
Parietal Lobe ◽  
Occipital Lobe ◽  
Skin Incision ◽  
Contralateral Side ◽  
Pineal Region ◽  
Good Choice ◽  
Venous System ◽  
Transcallosal Approach ◽  
Occipital Transtentorial Approach

OBJECTIVEPineal region meningiomas are rare and tend to be discovered only after they grow. Several simultaneous multidirectional approaches performed as a single operation have been proposed, but the best strategy to remove these deeply situated large meningiomas involving the deep vital venous system remains to be established. The authors advocate a multistaged, multidirectional approach to safely remove these challenging tumors.METHODSFour consecutive cases of meningioma in the pineal region were treated between April 2013 and June 2016. The 3 large (> 40 mm diameter) tumors were removed via multistaged, multidirectional approaches (2 surgeries in 2 patients and 3 surgeries in 1 patient) with gravity retraction of the occipital or parietal lobe. The large occipital skin incision extending bilaterally was used for the next operation from the contralateral side. Combinations of the occipital transtentorial approach with or without the transfalcine approach, occipital bitranstentorial/falcine approach, combined supra-/infratentorial transsinus approach, and contralateral parietal interhemispheric transcallosal approach were used.RESULTSTransient visual field deficits occurred after 2 of the 8 operations, but all tumors were removed grossly or subtotally without permanent surgery-related morbidity. The galenic venous system and straight sinus remained intact in all patients. During the follow-up period (mean 29.5 months [range 13–52 months]), there were no recurrences after the final operation.CONCLUSIONSA multistaged, multidirectional strategy with an intentional large occipital scalp incision and gravity retraction of the occipital lobe is a good choice for the safe removal of large meningiomas in the pineal region.

scholarly journals Co-Occurrence of Pineal-Region and Pituitary-Stalk Hemangioblastomas in a Patient Presenting with Von Hippel-Lindau Disease – A Case Report

2020 ◽  
Author(s):  
Gustavo Rassier Isolan ◽  
Gerson Evandro Perondi ◽  
Amauri Dalla-Corte ◽  
Allan Fernando Giovanini ◽  
João Paulo Mota Telles ◽  
...  
Keyword(s):  
Case Report ◽  
Neuron Specific Enolase ◽  
Vascular Lesion ◽  
Pineal Region ◽  
Pituitary Stalk ◽  
Fibrous Stroma ◽  
Pineal Region Tumor ◽  
Von Hippel Lindau ◽  
Transcallosal Approach ◽  
Vhl Disease

Abstract Introduction Hemangioblastomas of the pineal region or pituitary stalk are extremely rare. Only two cases of hemangioblastomas involving the pineal region have been reported, and four involving the pituitary stalk. The purpose of the present manuscript is to describe an unusual case of supposed hemangioblastoma found concomitantly in the pineal region and pituitary stalk of a patient diagnosed with Von Hippel-Lindau (VHL) disease. Case Report A 35-year-old female patient with a previous diagnosis of VHL complaining of occipital headaches and balance disturbances for three weeks, who previously had a cerebellar hemangioblastoma resected. The visual characteristics of the tumor suggested a friable vascular lesion with a reddish-brown surface, and an incisional biopsy was performed. The tumor consisted of a dense vascular network surrounded by fibrous stroma abundant in reticulin and composed by both fusiform and dispersed xanthomatous cells; the immunohistochemistry was immunopositive for neuron-specific enolase and immunonegative for epithelial membranous antigen. The patient has been monitored closely for 2 years, and the supratentorial masses have not presented any volume alteration. Conclusion This rare association must be taken into account in patients with VHL disease, or at least be suspected in patients who present a thickening of the pituitary stalk and a pineal-region mass. We believe a biopsy of our asymptomatic patient could have been dangerous due to inherent complications like intraoperative bleeding. We recommend close observation of asymptomatic lesions with MRIs every six months or until the lesions become symptomatic. If the pineal-region tumor does become symptomatic, gross resection via a transcallosal approach would be ideal.

The Posterior Transcallosal Approach to the Pineal Region and Posterior Third Ventricle: Intervenous and Paravenous Variants

2016 ◽  
Vol 13 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Prayash G. Patel ◽  
Aaron A. Cohen-Gadol ◽  
Philippe Mercier ◽  
Frederick A. Boop ◽  
Paul Klimo
Keyword(s):  
Third Ventricle ◽  
Signs And Symptoms ◽  
Pineal Region ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Tumor Type ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
Local Progression

Abstract BACKGROUND: There are a number of surgical approaches to the posterior third ventricle and pineal region, each with its associated advantages and disadvantages. OBJECTIVE: To present our experience with the posterior interhemispheric transcallosal approach and to analyze the indications, technique, and outcomes. METHODS: A retrospective study was conducted to identify and analyze all children and young adults who underwent the posterior transcallosal approach from July 2010 to March 2015. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up. RESULTS: Twenty-two patients (9 female, 13 male) were identified in 24 cases with a mean age of 10.5 years (range, 3-32 years). The most common tumor type was pineoblastoma (n = 6). Eleven patients underwent gross total resections; 11 underwent subtotal resections; and 2 tumors were biopsied. The intervenous operative corridor was used in 15 cases; the paravenous was used in 9. Of the 22 patients, 19 experienced 31 total postoperative events. There were 12 instances of contralateral weakness. Retraction-related hemiparesis was usually temporary; resection-related hemiparesis lasted longer. There were no complications related to occlusion of one or more bridging cortical veins or from thrombosis of 1 internal cerebral vein. Eight patients have died of tumor progression, and of the remaining 14 patients, only 1 patient to date has developed local progression. CONCLUSION: The posterior interhemispheric transcallosal approach allows resection of tumors located within the pineal region, posterior third ventricle, and thalamus. New postoperative neurological deficits can occur; however, many will improve significantly or resolve completely over time.

scholarly journals Human Midbrain Auditory Evoked Potentials Do Not Differ Between Bursts and Suppressions of Cortex Activity in Propofol Anesthesia: Case Report

2020 ◽  
Vol 5 (02) ◽  
Author(s):  
Anna O. Kantserova ◽  
Lyubov B. Oknina ◽  
Eugeny L. Masherov ◽  
Vitaly V. Podlepich ◽  
Maria I. Kamenetskaya ◽  
...  
Keyword(s):  
Evoked Potentials ◽  
General Anesthesia ◽  
Auditory Evoked Potentials ◽  
Obstructive Hydrocephalus ◽  
Pineal Region ◽  
Cerebral Aqueduct ◽  
Pineal Region Tumor ◽  
Transcallosal Approach ◽  
Total Length ◽  
Significant Difference

Propofol, the most widely administered anesthetic agent, is used for sedation and general anesthesia. During general anesthesia it can induce bursts and suppressions of cortex activity, which exact mechanism of generation has not been identified yet. The aim of study was to investigate the difference between midbrain auditory evoked potentials recorded during bursts and suppressions of cortex activity. These potentials were registered from the drainage-electrode implanted in the cerebral aqueduct of an adult patient with an obstructive hydrocephalus who had undergone pineal region tumor removal through anterior interhemispheric transcallosal approach. The cortex activity was divided into rare bursts of alpha activity (total length of 9 seconds) and prolonged suppressions (total length of 104 seconds). Midbrain auditory evoked potentials included long latency peaks with no statistically significant difference in their amplitudes and latencies between bursts and suppressions of cortex activity. The results suggest that human midbrain auditory evoked potentials do not differ between bursts and suppressions of cortex activity in propofol anesthesia. Therefore, for clear midbrain auditory evoked potentials cognitive but not the total electrical activity of the cortex should be suppressed.

scholarly journals Resection of a recurrent pineal region teratoma via a posterior interhemispheric transcallosal approach

2021 ◽  
Vol 5 (1) ◽  
pp. V13
Author(s):  
David S. Hersh ◽  
Scott Boop ◽  
Frederick A. Boop
Keyword(s):  
Unusual Case ◽  
Mature Teratoma ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Total Resection ◽  
Transcallosal Approach ◽  
Initial Surgery ◽  
Internal Cerebral Veins ◽  
Interhemispheric Fissure ◽  
Complex Lesions

The authors describe the unusual case of a 6-year-old boy presenting with decorticate posturing, diminished hearing, and an inability to open his eyes, despite being verbally responsive. He underwent a posterior interhemispheric transcallosal intervenous approach for resection of a pineal region mature teratoma, which recurred 2 years postoperatively. This video demonstrates his initial surgery and reresection, illustrating the value of this approach for more complex lesions that involve the internal cerebral veins (ICVs). At the time of recurrence, microsurgical dissection of the scarred interhemispheric fissure was required to facilitate removal of the multifocal recurrent teratoma, resulting in gross-total resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2134.

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