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

2016 ◽  
Vol 124 (1) ◽  
pp. 269-276 ◽  
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.

scholarly journals Resection of a pineal region papillary tumor using robotic exoscope: improved visualization and ergonomics for deep seeded tumor

2021 ◽  
Vol 5 (1) ◽  
pp. V14
Author(s):  
Wei X. Huff ◽  
Andrew J. Witten ◽  
Mitesh V. Shah
Keyword(s):  
Marked Improvement ◽  
Pineal Region ◽  
Operating Microscope ◽  
High Definition ◽  
Papillary Tumor ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Close Proximity ◽  
Supracerebellar Infratentorial Approach ◽  
Deep Location

Surgery for pineal region tumors is technically challenging due to their deep location and close proximity to critical deep venous structures, midbrain, and thalamus. A high-definition video exoscope was recently proposed as an alternative to the operating microscope. The authors illustrate a case of the midline supracerebellar infratentorial approach to resect a pineal region tumor using the Modus V exoscope and demonstrate the improved visualization of critical structures in this deep location. Additionally, the marked improvement in surgeon comfort suggests that this system may have significant advantages over traditional microscope-based surgery for tumors of the pineal region. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2127.

scholarly journals Our Experience with Infratentorial Supracerebellar (ITSC) Approach for Pineal Region Tumor Excision

2016 ◽  
Vol 12 (1) ◽  
pp. 38-39
Author(s):  
Gopal R Sharma ◽  
Prakash Bista ◽  
Nilam Khadka ◽  
Rajiv Jha ◽  
Maya Bhattachan ◽  
...  
Keyword(s):  
Obstructive Hydrocephalus ◽  
Air Embolism ◽  
Pineal Region ◽  
Treatment Modalities ◽  
Surgical Approaches ◽  
Good Recovery ◽  
Total Resection ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors

Pineal region tumors are rare and their incidence is less than 1% of primary CNS tumors. Varieties of tumors can be found in pineal region ranging from benign to malignant pathology. Treatment modalities ranged from biopsy to total excision of tumor. Many surgical approaches have been described in the literature, however, infratentorial supracerebellar ( ITSC ) approach is versatile and widely used by many neurosurgeons worldwide.The aim of this study is to analyze and discuss the surgical outcome of pineal region tumor using ITSC approach. Advantages and limitations of this approach will be discussed.This is a retrospective study of 10 patients who underwent microsurgical excision of pineal region masses using ITSC approach in sitting position under general anesthesia at our institute between April 2009 and March 2014. The follow up period ranged from 7 months to 5 years and outcome was measured with GOS (Glasgow Outcome Scale).There were 9 male and 1 female and age ranged from 10 to 50 years.Gross total resection was performed in all 10 cases using ITSC approach. 9 patients required VP shunt for obstructive hydrocephalus. 60% (6) had benign and 40% (4) had malignant pathology.Six patients suffered from postoperative complications which included air embolism ,pneumocephalus, pseudomeningocele and seizure.Eighty percent (8) have good recovery, 1 was severely disabled and 1 died.Advanced neurological techniques combined with neuroanesthesia, neuroimaging and postoperative critical care methods have made aggressive surgical resection a mainstay of management of pineal region tumors with excellent results.Nepal Journal of Neuroscience 12:31-37, 2015

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.

scholarly journals Interhemispheric occipital transtentorial approach to the pineal region and dorsal midbrain

2018 ◽  
Vol 20 (1) ◽  
pp. 22-26
Author(s):  
Andrei Fernandes Joaquim ◽  
Marcos Juliano Dos Santos ◽  
Élton Gomes Da Silva ◽  
Hélder Tedeschi
Keyword(s):  
Surgical Anatomy ◽  
Pineal Region ◽  
Sitting Position ◽  
Technical Aspects ◽  
Pineal Region Tumors ◽  
Supracerebellar Infratentorial Approach ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach ◽  
Wide Exposure

We describe the surgical anatomy and technical aspects of the interoccipital transtentorial approach to lesions of the dorsal midbrain and pineal region using the lateral-semiprone position. This approach offers a wide exposure of the posterior midbrain and pineal region tumors, avoiding the risks of the semi-sitting position used for the supracerebellar infratentorial approach. A step-by-step description of the approach is presented, with detailed anatomical pictures and case illustrations.

scholarly journals Combined supra/infratentorial-transsinus approach to large pineal region tumors

1998 ◽  
Vol 4 (4) ◽  
pp. E2
Author(s):  
Ibrahim M. Ziyal ◽  
Laligam N. Sekhar ◽  
Eduardo Salas ◽  
Wayne J. Olan
Keyword(s):  
Venous Pressure ◽  
Tumor Resection ◽  
Occipital Lobe ◽  
Transverse Sinus ◽  
Pineal Region ◽  
Combined Approach ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Nerve Paresis ◽  
Brain Retraction

Object The authors sought to confirm that the combined supra/infratentorial-transsinus approach offers a safer means of resecting large pineal region tumors than other approaches currently being used. The aforementioned method provides a wider exposure of the pineal region with less brain retraction than the infratentorial-supracerebellar or the occipital-transtentorial approach alone and is applicable to some large and giant tumors of this area. This combined approach was used in six patients to remove large pineal region tumors including four tentorial meningiomas, one pineocytoma, and one epidermoid cyst. Methods The transverse sinus and tentorium were sectioned after review of preoperative angiographic studies, after taking intraoperative measurements of the venous pressure in the nondominant transverse sinus before and after clipping and while monitoring the somatosensory evoked potentials. The occipital lobe cortex and cerebellum were retracted slightly along the tentorium. Deep veins of the galenic system, the quadrigeminal area, and the tumor were well exposed. Before it was used for tumor resection the approach was studied in five cadaveric head specimens, and the projection of different approaches was compared radiologically. The tumors were removed in a gross-total manner in all patients, and none of the major veins of the galenic system was injured. Resuturing of the nondominant transverse sinus was performed postoperatively in one patient. One of the six patients experienced transient visual loss, and another suffered mild right sixth cranial nerve paresis; however, both recovered in 3 weeks. The wide exposure of the combined approach was also confirmed on radiological and anatomical studies. Conclusions The combined supra/infratentorial-transsinus approach is preferred for the resection of certain large pineal region tumors.

scholarly journals Meningioma of the Pineal Region — Differential Radiologic Aspects of Pineal Region Tumors Based on a Clinical Case

2018 ◽  
Vol 37 (02) ◽  
pp. 145-147
Author(s):  
Tiago Avelar ◽  
Aline Paiva ◽  
Márcio Costa ◽  
Guilherme Aguiar ◽  
João Vitorino ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Case ◽  
Pineal Region ◽  
Differential Diagnoses ◽  
Benign Lesions ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
The Central Nervous System ◽  
Velum Interpositum

AbstractPineal region tumors are uncommon among neoplasm of the central nervous system, with this region being the most heterogeneous in terms of histological types. Meningiomas are rarer still, but can be found at this site, with origins in either the velum interpositum or falcotentorial junction. Neuroimaging exams can distinguish malignant from benign lesions besides helping to define the origin of the lesion as the pineal parenchymal or surrounding structures. We report the case of a woman with a pineal region tumor in which differential diagnoses included meningioma and germinoma, with confirmation of the former based on radiological characteristics and histopathology. In addition, a brief review of differential diagnoses and approaches for cases of lesions in this region is provided.

Meningiomas of the velum interpositum: surgical considerations

2003 ◽  
Vol 15 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Alan P. Lozier ◽  
Jeffrey N. Bruce
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Preoperative Imaging ◽  
Cerebral Veins ◽  
Pia Mater ◽  
Posterior Portion ◽  
Pineal Region Tumor ◽  
The Third ◽  
Supracerebellar Infratentorial Approach ◽  
Velum Interpositum

Meningiomas of the third ventricle are a rare subtype of pineal region tumor that arise from the posterior portion of the velum interpositum, the double layer of pia mater that forms the roof of the third ventricle. The authors review the literature concerning these meningiomas and present a case in which the lesion was resected via the supracerebellar–infratentorial approach. The relationship of the tumor to the deep venous system and the splenium of the corpus callosum guides the selection of the most advantageous surgical approach. Posterior displacement of the internal cerebral veins demonstrated on preoperative imaging provides a strong rationale for use of the supracerebellar–infratentorial approach.

scholarly journals Combined microsurgical-endoscopic paramedian supracerebellar-infratentorial approach for resection of a pineal low-grade glioma

2021 ◽  
Vol 5 (1) ◽  
pp. V9
Author(s):  
Juan M. Revuelta Barbero ◽  
Roberto M. Soriano ◽  
Rima S. Rindler ◽  
David P. Bray ◽  
Oswaldo Henriquez ◽  
...  
Keyword(s):  
Endoscopic Third Ventriculostomy ◽  
Third Ventricle ◽  
Pineal Region ◽  
Third Ventriculostomy ◽  
Low Grade ◽  
Total Resection ◽  
Blurred Vision ◽  
History Of ◽  
Supracerebellar Infratentorial Approach

The authors present the case of a 20-year-old male with a history of headaches and blurred vision found to have a pineal mass and chronic hydrocephalus. The patient initially underwent an endoscopic third ventriculostomy and pineal mass biopsy that revealed a low-grade neuroepithelial neoplasm. A microsurgery-endoscope–assisted paramedian supracerebellar-infratentorial approach was chosen and a gross-total resection was achieved. The patient’s postoperative and follow-up course has been unremarkable, with early postoperative imaging demonstrating no residual tumoral mass. The operative video highlights the advantages of endoscopic visualization for deep lesions in the pineal region and posterior third ventricle. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2119.

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