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 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.

Combined supra/infratentorial—transsinus approach to large pineal region tumors

1998 ◽  
Vol 88 (6) ◽  
pp. 1050-1057 ◽  
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 ◽  
Content Type ◽  
Pineal Region Tumors ◽  
Before And After ◽  
Fine Print

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 Endoscopic-assisted interhemispheric parieto-occipital transtentorial approach for microsurgical resection of a pineal region tumor: operative video and technical nuances

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
James K. Liu
Keyword(s):  
Occipital Lobe ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Straight Sinus ◽  
Occipital Transtentorial Approach ◽  
Microsurgical Resection ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The angle of the straight sinus and tentorium cerebelli can often influence the choice of surgical approach to the pineal region. The supracerebellar infratentorial approach can be technically challenging and a relative contraindication in cases where the angle of the straight sinus and tentorium is very steep. Similarly, an occipital transtentorial approach, which uses a low occipital craniotomy at the junction of the superior sagittal sinus and transverse sinus, may not provide the best trajectory to the pineal region in patients with a steep tentorium. In addition, this approach often necessitates retraction on the occipital lobe to access the tentorial incisura and pineal region, which can increase the risk of visual compromise. In this operative video, the author demonstrates an alternative route using an endoscopic-assisted interhemispheric parieto-occipital transtentorial approach to a pineal region tumor in a patient with a steep straight sinus and tentorium. The approach provided a shorter route and more direct trajectory to the tumor at the tentorial incisura, and avoided direct fixed retraction on the occipital lobe when performed using the lateral position, thereby minimizing visual complications. This video atlas demonstrates the operative technique and surgical nuances, including the application of endoscopic-assisted microsurgical resection and operative pearls for preservation of the deep cerebral veins. In summary, the parieto-occipital transtentorial approach with endoscopic assistance is an important approach in the armamentarium for surgical management of pineal region tumors.The video can be found here: https://youtu.be/Ph4veG14aTk.

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 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 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.

Exclusive Endoscopic Occipital Transtentorial Approach for Pineal Region Tumors

2019 ◽  
Vol 131 ◽  
pp. 167-173 ◽  
Author(s):  
Motoki Tanikawa ◽  
Hiroshi Yamada ◽  
Tomohiro Sakata ◽  
Yasuhiko Hayashi ◽  
Yasuo Sasagawa ◽  
...  
Keyword(s):  
Pineal Region ◽  
Pineal Region Tumors ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach

Prevention of Superior Petrosal Vein Injury during Microvascular Decompression for Trigeminal Neuralgia: Operative Nuances

2021 ◽  
Author(s):  
Minsoo Kim ◽  
Sang-Ku Park ◽  
Seunghoon Lee ◽  
Jeong-A Lee ◽  
Kwan Park
Keyword(s):  
Trigeminal Neuralgia ◽  
Microvascular Decompression ◽  
Patient Positioning ◽  
Vestibulocochlear Nerve ◽  
Neurophysiologic Monitoring ◽  
Petrosal Vein ◽  
Cerebrospinal Fluid Leaks ◽  
Superior Petrosal Vein ◽  
Surgical Corridor ◽  
Vein Injury

Abstract Background The superior petrosal vein (SPV) often obscures the surgical field or bleeds during microvascular decompression (MVD) for the treatment of trigeminal neuralgia. Although SPV sacrifice has been proposed, it is associated with multiple complications. We have performed more than 4,500 MVDs, including approximately 400 cases involving trigeminal neuralgia. We aimed to describe our operative technique and nuances to avoid SPV injury. Methods We have provided a detailed description of our institutional protocol, including the anesthesia technique, neurophysiologic monitoring, patient positioning, surgical approach, and SPV management. The surgical outcomes and treatment-related complications were retrospectively analyzed. Results No SPVs were sacrificed intentionally or accidentally during our MVD protocol for trigeminal neuralgia. In the 344 operations performed during 2006 to 2020, 269 (78.2%) patients did not require medication postoperatively, 58 (16.9%) tolerated the procedure with adequate medication, and 17 (4.9%) did not respond to MVD. Postoperatively, 35 (10.2%), 1 (0.3%), and 0 patients showed permanent trigeminal, facial, or vestibulocochlear nerve dysfunction, respectively. Wound infection occurred in five (1.5%) patients, while cerebrospinal fluid leaks occurred in three (0.9%) patients. Hemorrhagic complications appeared in four (1.2%) patients but these were unrelated to SPV injury. No surgery-related mortalities were reported. Conclusion MVD for the treatment of trigeminal neuralgia can be achieved safely without sacrificing the SPV. A key step is positioning the patient's vertex at a 10-degree elevation from the floor, which can ease venous return and loosen the SPV, making it less fragile to manipulation and providing a wider surgical corridor.

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