scholarly journals Posterior interhemispheric transtentorial approach for resection of a meningioma at the posteromedial tentorial incisura

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Sun Liyong ◽  
Yuhai Bao ◽  
Jiantao Liang ◽  
Mingchu Li ◽  
Jian Ren
Keyword(s):  
Third Ventricle ◽  
Symptomatic Improvement ◽  
Pineal Region ◽  
Increased Intracranial Pressure ◽  
Total Removal ◽  
Adjacent Structures ◽  
Patient Reported ◽  
Surgical Corridor ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The posterior interhemispheric approach is a versatile approach to access lesions of the pineal region, posterior incisural space, posterior region of third ventricle, and adjacent structures. We demonstrate the case of a 26-year-old woman with symptoms of increased intracranial pressure and hydrocephalus caused by a meningioma at the posteromedial tentorial incisura. Gross-total removal of the tumor was successfully achieved via a posterior interhemispheric transtentorial approach. The patient reported an immediate and significant symptomatic improvement after surgery. The detailed operative technique and surgical nuances, including the surgical corridor, tentorium incision, tumor dissection and removal are illustrated in this video atlas.The video can be found here: https://youtu.be/nSNyjQKl7aE.

scholarly journals Meningioma of posterolateral tentorial incisura: a case demonstration of paramedian supracerebellar transtentorial approach

2021 ◽  
Vol 5 (1) ◽  
pp. V8
Author(s):  
Abdullah Keles ◽  
Burak Ozaydin ◽  
Mustafa K. Baskaya
Keyword(s):  
Pineal Region ◽  
Neurological Deficits ◽  
Total Resection ◽  
Tumor Extension ◽  
History Of ◽  
Tectal Plate ◽  
Pros And Cons ◽  
Ambient Cistern ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The paramedian supracerebellar transtentorial approach allows unobstructed exposure to the quadrigeminal cistern, tectal plate, pineal region, tentorial incisura, medial basal temporal lobe, and posterior ambient cistern. The authors present a meningioma of the posterolateral tentorial incisura case in a 62-year-old male who presented with a long history of upper-extremity tremors and walking difficulties. MRI revealed supra- and infratentorial tumor extension and hydrocephalus. This approach enabled us to achieve gross-total resection without causing neurovascular injury or any postoperative neurological deficits. For each pathology, the pros and cons of various approaches should be considered based on the anatomy, vasculature, and any surrounding structures. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2138.

Meningiomas of the Pineal Region and Third Ventricle

Neurosurgery ◽  
1979 ◽  
Vol 5 (4) ◽  
pp. 489-495 ◽  
Author(s):  
Rodney Rozario ◽  
Lester Adelman ◽  
Robert J. Prager ◽  
Bennett M. Stein
Keyword(s):  
Clinical Presentation ◽  
English Literature ◽  
Third Ventricle ◽  
Pineal Region ◽  
Radiological Findings ◽  
Total Removal ◽  
True Nature ◽  
Preoperative Diagnostic ◽  
Dural Attachment ◽  
Velum Interpositum

Abstract The clinical presentation, radiological findings, and surgical management of two cases of meningioma arising from the velum interpositum without dural attachment are described. The true nature of these tumors was not suspected despite extensive preoperative diagnostic evaluation. A total removal was effected in both cases with the use of the operating microscope and a posterior fossa approach to the pineal region. A review of similar cases from the English literature is presented.

Fully Endoscopic Supracerebellar Infratentorial Approach for Resection of Third Ventricle Germ Cell Tumor: 2-Dimensional Operative Video

2018 ◽  
Vol 16 (3) ◽  
pp. 389-390 ◽  
Author(s):  
Jianping Song ◽  
Wei Hua ◽  
Zhiguang Pan ◽  
Wei Zhu
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Upper Body ◽  
Pineal Tumor ◽  
High Definition ◽  
Deep Drainage ◽  
Posterior Portion ◽  
The Third ◽  
Supracerebellar Infratentorial Approach ◽  
Surgical Corridor

Abstract Pineal tumor that extends into the posterior portion of the third ventricle is extremely deep-seated and surgically challenging. Various microscopic approaches have been introduced to acquire access to the posterior third ventricle, but still the exposure and visualization are relatively unfavorable. However, recently the application of high-definition endoscope gave neurosurgeons a much more magnified and clearer view of anatomy around the pineal region and third ventricle. The widely used supracerebellar infratentorial approach has been proven to offer a sufficient surgical corridor for fully endoscopic surgery for pineal tumor. We presented a case of a 13-yr-old male child with a posterior third ventricle tumor, which was surgically resected fully with the endoscope. An informed consent has been obtained from the patient and his guardians. In order to gain enough auto-retraction by gravity, diminish the pitfalls of the semisitting position, and enhance the surgeon's ergonomics, the patient was positioned with a modified “head-up” park bench position (the upper body was elevated and the head was slightly extended instead of anteflexion). The tumor was approached through suboccipital midline supracerebellar infratentorial trajectory. The superficial and deep drainage veins above the vermis were sacrificed and the quadrigeminal cistern was entered to expose the tumor. The first and the most important step of the operation was to de-vascularize the tumor bilaterally, then the tumor could be debulked and circumferentially resected. The gross total resection was achieved. Fully endoscopic supracerebellar infratentorial approach is feasible and efficient when addressing lesions located at the posterior portion of the third ventricle.

scholarly journals Pretemporal transcavernous transtentorial approach for right pontine cavernous malformation

2019 ◽  
Vol 1 (1) ◽  
pp. V5 ◽  
Author(s):  
Xavier T. J. Hsu ◽  
Chih-Hsiang Liao ◽  
Chun-Fu Lin ◽  
Sanford P. C. Hsu
Keyword(s):  
Mental Status ◽  
Cavernous Malformation ◽  
Vascular Lesion ◽  
Slow Flow ◽  
Total Removal ◽  
Posterior Clinoid Process ◽  
Acute Changes ◽  
The Right ◽  
Surgical Corridor ◽  
Transtentorial Approach

A 57-year-old man presented with acute changes in mental status. Brain CT showed a high-density lesion at the pons. Brain MRA revealed a very slow-flow vascular lesion at the right aspect of the pons, about 3.9 ⋅ 3.0 ⋅ 3.0 cm3, compatible with a pontine cavernous malformation (CM). Gross-total removal was achieved. In this approach, a wider surgical corridor was obtained by opening the Meckel’s cave and cutting the tentorium. For a midline attack point on the pons, additional removal of the posterior clinoid process can meet the goal. In the authors’ opinion, this approach is safe and effective in selected ventrolateral pontine CMs.The video can be found here: https://youtu.be/moHqEkp5eCA.

scholarly journals Supracerebellar infratentorial sitting craniotomy for a pinealoblastoma

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Omar Choudhri ◽  
Steven D. Chang
Keyword(s):  
Third Ventricle ◽  
Tumor Resection ◽  
Standard Of Care ◽  
Surgical Anatomy ◽  
Pineal Region ◽  
Who Grade ◽  
Biopsy Site ◽  
Supracerebellar Infratentorial Approach ◽  
Aggressive Tumors ◽  
Tentorial Incisura

Pinealoblastomas are WHO grade IV tumors of the pineal region and comprise up to 50% of all pineal parenchymal tumors. They are highly aggressive tumors that spread along the craniospinal axis and are most commonly seen in children. The standard of care involves maximal surgical resection and chemoradiation following tissue diagnosis. We present the rare case of a large pinealoblastoma in an 18-year-old girl who presented with headaches and Parinaud's syndrome from tectal compression. An attempt was made at endoscopic transventricular biopsy of the tumor at an outside hospital, but it was aborted given bleeding at the biopsy site. We performed a supracerebellar infratentorial approach in a sitting position to achieve a gross-total resection of the tumor. This video case illustrates techniques for setting up a sitting craniotomy and approaching a previously biopsied hemorrhagic pinealoblastoma. The venous conglomerate at the tentorial incisura was found to be enveloped by the tumor and a thickened arachnoid scar. Surgical anatomy of the third ventricle and the pineal region is illustrated in this case through the process of surgical dissection and tumor resection.The video can be found here: https://youtu.be/CzB0lFQ7AyI.

Microsurgical Anatomy of the Venous Drainage of the Mesencephalodiencephalic Junction

Neurosurgery ◽  
2004 ◽  
Vol 54 (3) ◽  
pp. 678-686 ◽  
Author(s):  
Patrick Chaynes
Keyword(s):  
Third Ventricle ◽  
Posterior Part ◽  
Pineal Region ◽  
Pineal Body ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Microsurgical Anatomy ◽  
Jugular Veins ◽  
Topographic Anatomy ◽  
Adjacent Structures

Abstract OBJECTIVE The veins draining the posterior wall of the third ventricle and its adjacent structures and the posterior part of the midbrain have been the most neglected of the intracranial vascular structures in both the anatomic and neurosurgical literature. During our dissections of the pineal region and the quadrigeminal cistern, we did not always encounter topographic anatomy as described in previous articles. The purpose of this study is to describe the topographic anatomy and normal variations of the specific veins that drain the collicular plate and the pineal body and their adjacent structures with a view to better defining neurosurgical approaches to the pineal region. METHODS The deep cerebral veins draining the pineal body, the collicular plate, and their surrounding neural structures were examined on both sides of 25 adult cadaveric brains. In all specimens, the carotid and vertebral arteries and the jugular veins were perfused with red or blue silicone, respectively, to facilitate dissection under ×3 to ×40 magnification. RESULTS The venous plexus on the dorsal aspect of the collicular plate drains via collicular veins according to three different patterns. These types of drainage are closely related to the existence or absence of the basal vein on one or both sides. CONCLUSION The veins draining the superior and inferior aspects of the pineal body form a superior and an inferior pineal vein that usually drain into the internal or great cerebral vein.

The Petrosal Approach for the Resection of Retrochiasmatic Craniopharyngiomas

2008 ◽  
Vol 62 (suppl_5) ◽  
pp. ONS331-ONS336 ◽  
Author(s):  
Ossama Al-Mefty ◽  
Samer Ayoubi ◽  
Paulo A.S. Kadri
Keyword(s):  
Blood Supply ◽  
Web Site ◽  
Third Ventricle ◽  
Pituitary Stalk ◽  
Direct Visualization ◽  
Video Presentation ◽  
The Third ◽  
Functional Integrity ◽  
Surgical Corridor ◽  
Transtentorial Approach

Abstract THE PETROSAL (PRESIGMOID transtentorial) approach has been advocated for resecting retrochiasmatic craniopharyngiomas. The projection of the surgical corridor, posterior to anterior and inferior upward, is particularly valuable in dissecting the upper pole of the tumor, which projects high into the third ventricle. This approach allows direct visualization for dissecting the hypothalamus and the pituitary stalk, and maintaining their blood supply and functional integrity. With a web site video presentation, we demonstrate the operative nuances of the approach to these tumors. We recommend this approach for patients with large and giant retrochiasmatic craniopharyngiomas.

scholarly journals Combined bi-occipital suboccipital transsinus transtentorial approach for resection of a pineal region falcotentorial meningioma: operative video and technical nuances

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
James K. Liu
Keyword(s):  
Venous Pressure ◽  
Patient Positioning ◽  
Occipital Lobe ◽  
Transverse Sinus ◽  
Pineal Region ◽  
Neurophysiologic Monitoring ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Surgical Corridor ◽  
Transtentorial Approach

Large deep-seated meningiomas of the falcotentorial region present a formidable surgical challenge. In this operative video, the author demonstrates the combined bi-occipital suboccipital transsinus transtentorial approach for microsurgical resection of a large falcotentorial meningioma. This approach involves division of the less dominant transverse sinus after assessment of the venous pressure before and after clipping of the sinus with continuous neurophysiologic monitoring. Mild retraction of the occipital lobe and cerebellum results in a wide supra- and infratentorial exposure of extensive pineal region tumors. This video atlas demonstrates the operative technique and surgical nuances, including patient positioning, supra- and infratentorial craniotomy, transsinus transtentorial incision, and tumor removal with preservation of the vein of Galen complex. In summary, the combined bi-occipital suboccipital transsinus transtentorial approach provides a wide supra- and infratentorial surgical corridor for removal of select falcotentorial meningiomas.The video can be found here: https://youtu.be/3aD8h2uwBAo.

scholarly journals Introduction to Microsurgery of the Third Ventricle, Pineal Region, and Tentorial Incisura

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Fredric B. Meyer ◽  
Jeffrey N. Bruce
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Three Dimensions ◽  
Patient Harm ◽  
The Third ◽  
Head Positioning ◽  
Brain Retraction ◽  
Tentorial Incisura ◽  
Neurovascular Anatomy ◽  
Standard Operations

This edition of the Video Supplement entitled “Microsurgery of the Third Ventricle, Pineal Region, and Tentorial Incisura” highlights approaches to accessing the third ventricle for surgical resection of a variety of pathologies. The third ventricle has critical neurovascular anatomy that must always be respected to prevent patient harm. Visualization of critical anatomy in three dimensions from a surgeon' line of sight is important when planning the optimum surgical approach. Some of the keys to safely operating in this region include thoughtful head positioning, limitation of brain retraction, and the use of trajectories which capitalize on CSF cisterns and fissures. Some of the videos included in this volume illustrate standard operations while others depict more unique and innovative approaches that take advantage of these surgical windows. We hope you enjoy the videos included in this supplement.

scholarly journals GCT-47. TREATMENT STRATEGIES FOR GIANT IMMATURE TERATOMAS IN INFANTS

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii337-iii337
Author(s):  
Tomoru Miwa ◽  
Maya Kono ◽  
Haruko Shima ◽  
Hiroyuki Shimada ◽  
Kazunari Yoshida
Keyword(s):  
Poor Prognosis ◽  
Third Ventricle ◽  
Treatment Strategies ◽  
Fetal Brain ◽  
External Ventricular Drainage ◽  
Pineal Region ◽  
Maximum Diameter ◽  
Ventricular Drainage ◽  
Total Removal ◽  
Tumor Removal

Abstract INTRODUCTION Immature teratomas are the most frequent fetal brain tumors and show a poor prognosis. At onset, the tumor is often already giant with deep origins such as suprasellar or pineal region, and easy bleeding is also considered to be a cause of poor prognosis. On the other hand, it is also known that the prognosis is improved in total removal cases. METHODS We investigated the best treatment strategy based on two cases of total removal of giant immature teratomas in infants. RESULTS 1.5 month after birth at onset (median), maximum diameter of 75 mm (median). A giant tumor centered around the third ventricle with hydrocephalus. First, biopsy (+septostomy) was performed using an endoscope. The tumor showed easily bleeding. In addition, external ventricular drainage was taken out of the lower abdomen subcutaneously by long tract. After chemotherapy (carboplatin and etoposide), tumor removal was performed by using drainage tract. Both cases showed not easily bleeding at that time and the tumor was safely removed. Regarding the deep blind spot, using a flexible endoscope was effective. They showed no recurrence after total removal (median 50 months). DISCUSSION There have been reports of cases in which chemotherapy for immature teratomas suppressed tumor growth and reduced bleeding and safely removed totally. In infants giant immature teratomas, chemotherapy before tumor removal can be expected to reduce bleeding, and further increase body weight during that period. In addition, long-term placement of ventricular drainage by long tract during the chemotherapy can prevent brain development delay due to hydrocephalus.

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