The Role of Gross Total Resection in the Management of Pineal Region Tumors

Abstract Cavernous malformations of the third ventricle are uncommon vascular lesions. Evidence suggests that cavernous malformations in this location might have a more aggressive natural history due to their risk of intraventricular hemorrhage and hydrocephalus.1 The gold standard of treatment is considered to be microsurgical gross total resection of the lesion. However, with progressive improvement in endoscopic capabilities, several authors have recently advocated for the role of minimally-invasive neuroendoscopy for resecting intraventricular cavernous malformations.2-4 In this timely intraoperative video, we demonstrate the gross total resection of a third ventricle cavernous malformation that presented with hemorrhage via a right-sided trans-frontal neuroendoscopic approach.

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Lateral supracerebellar infratentorial approach for microsurgical resection of large midline pineal region tumors: techniques to expand the operative corridor

Journal of Neurosurgery ◽

10.3171/2015.2.jns142088 ◽

2016 ◽

Vol 124 (1) ◽

pp. 269-276 ◽

Cited By ~ 11

Author(s):

Charles Kulwin ◽

Ken Matsushima ◽

Mahdi Malekpour ◽

Aaron A. Cohen-Gadol

Keyword(s):

Transverse Sinus ◽

Lateral Approach ◽

Pineal Region ◽

Related Complication ◽

Total Resection ◽

Pineal Region Tumor ◽

Pineal Region Tumors ◽

Suboccipital Craniotomy ◽

Bridging Veins ◽

Supracerebellar Infratentorial Approach

Pineal region tumors pose certain challenges in regard to their resection: a deep surgical field, associated critical surrounding neurovascular structures, and narrow operative working corridor due to obstruction by the apex of the culmen. The authors describe a lateral supracerebellar infratentorial approach that was successfully used in the treatment of 10 large (> 3 cm) midline pineal region tumors. The patients were placed in a modified lateral decubitus position. A small lateral suboccipital craniotomy exposed the transverse sinus. Tentorial retraction sutures were used to gently rotate and elevate the transverse sinus to expand the lateral supracerebellar operative corridor. This approach placed only unilateral normal structures at risk and minimized vermian venous sacrifice. The surgeon achieved generous exposure of the caudal midline mesencephalon through a “cross-court” oblique trajectory, while avoiding excessive retraction on the culmen. All patients underwent the lateral approach with no approach-related complication. The final pathological diagnoses were consistent with meningioma in 3 cases, pilocytic astrocytoma in 3 cases, intermediate grade pineal region tumor in 2 cases, and pineoblastoma in 2 cases. The entire extent of these tumors was readily reachable through the lateral supracerebellar route. Gross-total resection was achieved in 8 (80%) of the 10 cases; in 2 cases (20%) near-total resection was performed due to adherence of these tumors to deep diencephalic veins. Large midline pineal region tumors can be removed through a unilateral paramedian suboccipital craniotomy. This approach is simple, may spare some of the midline vermian bridging veins, and may be potentially less invasive and more efficient.

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Retractorless interforniceal approach for microsurgical resection of a papillary tumor of the pineal region: operative video and technical nuances

Neurosurgical Focus: Video ◽

10.3171/2021.4.focvid2139 ◽

2021 ◽

Vol 5 (1) ◽

pp. V12

Author(s):

James K. Liu ◽

Neil Majmundar

Keyword(s):

Obstructive Hydrocephalus ◽

Third Ventricle ◽

Lateral Position ◽

Pineal Region ◽

Gross Total Resection ◽

Cerebral Aqueduct ◽

Papillary Tumor ◽

Total Resection ◽

Microsurgical Resection ◽

Neurologically Intact

In this illustrative video, the authors demonstrate microsurgical resection of a papillary tumor of the pineal region using a retractorless interforniceal approach via the anterior interhemispheric transcallosal route. The tumor presented to the posterior third ventricle occluding the cerebral aqueduct, resulting in obstructive hydrocephalus. The retractorless interforniceal approach is performed in the lateral position with BICOL collagen spacers to keep the corridor open. Gross-total resection was achieved, and the patient was neurologically intact without needing a permanent shunt. The operative nuances and pearls of technique for safe microdissection and gentle handling of the retractorless interforniceal approach are demonstrated. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2139.

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The Role of Neuroendoscopy in the Treatment of Pineal Region Tumors

JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA ◽

10.22290/jbnc.v22i2.953 ◽

2018 ◽

Vol 22 (2) ◽

pp. 21-25

Author(s):

Flávio Ramalho Romero ◽

Eduardo De Freitas Bertolini ◽

Adalberto Sestari ◽

Sérgio Soares Guerrero ◽

Ramon Barbalha Guerrero ◽

...

Keyword(s):

Diagnostic Yield ◽

Pineal Region ◽

Endoscopic Biopsy ◽

Third Ventriculostomy ◽

Tumor Biopsy ◽

Pineal Tumors ◽

Pineal Region Tumors ◽

Therapeutic Outcomes ◽

Initial Procedure

Object. The authors report their experience in six patients presenting with pineal tumors and associated hydrocephalus who underwent an endoscopic biopsy procedure and third ventriculostomy (ETV) in a single setting. The purpose of this report is to discuss the role of neuroendoscopic procedures in the management of pineal region tumors. Methods. A retrospective review of patients undergoing simultaneous ETV and tumor biopsy was ndertaken. Neuroendoscopic surgery was first applied for tumor debulking with tissue diagnosis and gross morphological analysis of the tumor and the intraventricular structures, followed by third ventriculostomy. Subsequent procedures were determined on the basis of verified individual tumors. Results. Over a 2-year interval, 6 patients underwent simultaneous ETV and tumor management. These patients ranged from 6 to 54 years of age (mean 24.3 years). All cases were completed without complications or the need for an additional CSF diversionary procedure within 6 months. The diagnostic yield of the biopsy was 100%. Favorable therapeutic outcomes were obtained in all cases of germinoma and pineoblastoma, with follow-up periods ranging from 6 to 24 months. Conclusion. The majority of our patients with dilated ventricles were treated satisfactorily with effective neuroendoscopic procedures as the initial procedure, avoiding unnecessary craniotomy and promising excellent therapeutic outcomes.

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The Role of Gross Total Resection in Low-Grade Gliomas

Controversies in Neuro-Oncology ◽

10.1055/b-0034-91010 ◽

2014 ◽

Keyword(s):

Gross Total Resection ◽

Low Grade ◽

Total Resection ◽

Low Grade Gliomas

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The role of neuroendoscopy in the treatment of pineal region tumors

Surgical Neurology ◽

10.1016/s0090-3019(97)00018-9 ◽

1997 ◽

Vol 48 (4) ◽

pp. 360-367 ◽

Cited By ~ 80

Author(s):

Shenandoah Robinson ◽

Alan R. Cohen

Keyword(s):

Pineal Region ◽

Pineal Region Tumors

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Utility of sodium fluorescein for achieving resection targets in glioblastoma: increased gross- or near-total resections and prolonged survival

Journal of Neurosurgery ◽

10.3171/2018.10.jns181174 ◽

2020 ◽

Vol 132 (3) ◽

pp. 914-920 ◽

Cited By ~ 1

Author(s):

Gennadiy A. Katsevman ◽

Ryan C. Turner ◽

Ogaga Urhie ◽

Joseph L. Voelker ◽

Sanjay Bhatia

Keyword(s):

Median Survival ◽

Case Series ◽

Retrospective Chart Review ◽

Treated Group ◽

Gross Total Resection ◽

Sodium Fluorescein ◽

Total Resection ◽

Teaching Institution ◽

Systemic Side Effects

OBJECTIVEIt is commonly reported that achieving gross-total resection of contrast-enhancing areas in patients with glioblastoma (GBM) improves overall survival. Efforts to achieve an improved resection have included the use of both imaging and pharmacological adjuvants. The authors sought to investigate the role of sodium fluorescein in improving the rates of gross-total resection of GBM and to assess whether patients undergoing resection with fluorescein have improved survival compared to patients undergoing resection without fluorescein.METHODSA retrospective chart review was performed on 57 consecutive patients undergoing 64 surgeries with sodium fluorescein to treat newly diagnosed or recurrent GBMs from May 2014 to June 2017 at a teaching institution. Outcomes were compared to those in patients with GBMs who underwent resection without fluorescein.RESULTSComplete or near-total (≥ 98%) resection was achieved in 73% (47/64) of fluorescein cases. Of 42 cases thought not to be amenable to complete resection, 10 procedures (24%) resulted in gross-total resection and 15 (36%) resulted in near-total resection following the use of sodium fluorescein. No patients developed any local or systemic side effects after fluorescein injection. Patients undergoing resection with sodium fluorescein, compared to the non–fluorescein-treated group, had increased rates of gross- or near-total resection (73% vs 53%, respectively; p < 0.05) as well as improved median survival (78 weeks vs 60 weeks, respectively; p < 0.360).CONCLUSIONSThis study is the largest case series to date demonstrating the beneficial effect of utilizing sodium fluorescein as an adjunct in GBM resection. Sodium fluorescein facilitated resection in cases in which it was employed, including dominant-side resections particularly near speech and motor regions. The cohort of patients in which sodium fluorescein was utilized had statistically significantly increased rates of gross- or near-total resection. Additionally, the fluorescein group demonstrated prolonged median survival, although this was not statistically significant. This work demonstrates the promise of an affordable and easy-to-implement strategy for improving rates of total resection of contrast-enhancing areas in patients with GBM.

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The role of intraoperative ultrasound in gross total resection of brain mass lesions and outcome

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-019-0117-4 ◽

2019 ◽

Vol 55 (1) ◽

Author(s):

Wael Abd Elrahman Ali Elmesallamy

Keyword(s):

Intraoperative Ultrasound ◽

Gross Total Resection ◽

Mass Lesion ◽

University Hospitals ◽

Conventional Surgery ◽

Total Resection ◽

Brain Mass ◽

Mass Lesions

Abstract Background Surgical resection of brain mass lesion mandates safety and the best outcome for the patient. Objectives The aim of this study was the evaluation of intraoperative ultrasound (IOUS) in gross total resection of brain mass lesions and patients’ safety in comparison to conventional surgery. Materials and methods In total, 632 patients were operated for brain mass lesion resection at Neurosurgery Department, Zagazig University Hospitals, during the period from January 2011 to October 2018 and divided randomly into two groups, IOUS group and conventional group, for the detection value of IOUS in resection, safety, and outcome after 3 months follow-up. Results The IOUS group showed statistically significant gross total resection regardless to pathology, location, size, age, and sex in favor of IOUS use, and also, there were significantly less complications and better outcome after 3 months follow-up with the IOUS group. Significantly better outcome was found with gross total resection in total surgeries. Conclusions The use of IOUS during brain mass lesion surgery is safe and can assist the surgeon in gross total resection with better outcome.

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