scholarly journals Left occipital craniotomy for resection of falcotentorial meningioma

2017 ◽  
Vol 43 (videosuppl2) ◽  
pp. V9 ◽  
Author(s):  
William T. Couldwell
Keyword(s):  
Lateral Position ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
Venous Anatomy ◽  
Link Type ◽  
Interhemispheric Approach ◽  
Internal Cerebral Veins ◽  
Cognitive Difficulty ◽  
Tumor Debulking

A 49-year-old man presented with headache and cognitive difficulty. MRI demonstrated a meningioma in the falcotentorial region with compression of the internal cerebral veins, basal veins of Rosenthal, and vein of Galen. It was a removed via a left-sided occipital interhemispheric approach, performed with the patient in the lateral position. After tumor debulking and removal of its attachment to the tentorium and anterior falx, the tumor was resected. All venous structures were preserved. The video demonstrates the technical nuances and strategy for removal of tumors in a region with complicated venous anatomy that must be preserved.The video can be found here: https://youtu.be/wKqAn3dYu4E.

scholarly journals Right Anterior Parasagittal Craniotomy and Interhemispheric Approach for Resection of a Falcontentorial Junction Meningioma: 2-Dimensional Operative Video

2019 ◽  
Vol 17 (6) ◽  
pp. E237-E238
Author(s):  
Benjamin K Hendricks ◽  
Robert F Spetzler
Keyword(s):  
Video Recording ◽  
Cortical Blindness ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
Falx Cerebri ◽  
Sagittal Sinus ◽  
Institutional Review Board Approval ◽  
Interhemispheric Approach ◽  
Institutional Review ◽  
Internal Cerebral Veins

Abstract Falcotentorial meningiomas are rare lesions that occur along the midline at the junction of the falx cerebri and tentorium. When large, these lesions pose a surgical challenge because of the risk of neurologic deficits, including cortical blindness. Delicate structures at risk during resection of these lesions include the sagittal sinus, internal cerebral veins, vein of Galen, straight sinus, torcula, and fornix. Although there are a number of very reasonable approaches, including a supracerebellar infratentorial or occipital interhemispheric, we chose an anterior interhemispheric approach to provide the safest route for accessing the largest portion of the tumor while protecting the deep venous system.  After identification of the falcine attachment, the tumor is debulked within the tumor capsule. In this case, the tumor was subtotally removed because of the adherence of a small segment of tumor along the vein of Galen. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute.

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.

The Enigmatic Psalterium: A Review and Anatomic Study With Relevance to Callosotomy Procedures

2015 ◽  
Vol 11 (2) ◽  
pp. 322-328 ◽  
Author(s):  
R Shane Tubbs ◽  
Anand N Bosmia ◽  
Tulika Gupta ◽  
Kunal Chawla ◽  
Marios Loukas ◽  
...  
Keyword(s):  
Fiber Direction ◽  
Cerebral Veins ◽  
Average Thickness ◽  
Vein Of Galen ◽  
Posterior Border ◽  
Anatomic Study ◽  
Internal Cerebral Veins ◽  
Mean Width ◽  
Velum Interpositum ◽  
Adult Cadaver

Abstract BACKGROUND Recalcitrant seizures after callosotomy procedures are challenging to treat. One commissure, the psalterium, has received little attention. OBJECTIVE To review the literature on this structure, and with dissection, better elucidate its morphology and relationships. METHODS Twenty adult cadaver brains underwent microsurgical dissection of the psalterium. Measurements included the size and distance from the splenium of the corpus callosum and posterior border of the hippocampus tail. Observations included the relationships between the psalterium and the vein of Galen and the fiber direction within this structure. RESULTS The psalterium was identified in all specimens. It intimately contacted the undersurface of the splenium superiorly and the velum interpositum inferiorly. It was always in the midline. Just posterior to the psalterium, the internal cerebral veins were found leaving the velum interpositum to drain into the vein of Galen. In most specimens, the psalterium fibers traveled in the same plane as the commissural fibers of the splenium. Mean width of the psalterium was 11 mm; mean length was 13 mm. Average thickness in the midline was 1.4 mm, and at the lateral edges, it was generally thicker as it joined the fornix with an average of 2 mm. In 30%, efferents from the hippocampus were arranged in the form of a sheet bilaterally rather than the normal bundle-like formation forming the posterior crura. CONCLUSION Better understanding of the commissures of the human brain, including the psalterium, might help the neurosurgeon during procedures near this structure.

Anatomy of the deep venous system in vein of Galen malformation and its changes after endovascular treatment depicted by magnetic resonance venography

2018 ◽  
Vol 11 (1) ◽  
pp. 84-89 ◽  
Author(s):  
Olivia Winkler ◽  
Waleed Brinjikji ◽  
Heinrich Lanfermann ◽  
Friedhelm Brassel ◽  
Dan Meila
Keyword(s):  
Endovascular Treatment ◽  
Venous Drainage ◽  
Venous System ◽  
Cerebral Veins ◽  
Common Phenomenon ◽  
Vein Of Galen ◽  
Vein Of Galen Malformation ◽  
Deep Venous System ◽  
Internal Cerebral Veins ◽  
Lateral Mesencephalic Vein

Background and purposeIt is classically thought that the internal cerebral veins (ICV) do not communicate with the venous pouch of vein of Galen malformations (VGM). We report on the anatomy of the deep venous system in VGM with special emphasis on the drainage of the ICV and possible changes after endovascular treatment.Materials and methodsWe retrospectively analyzed DSA and 2D time-of-flight MR venograms of 55 children with VGM. We evaluated all pre- and post-operative images for the presence of the ICVs and determined their route of venous drainage.ResultsOf 55 children, pre-operative 2D MRV detected the ICVs in 19 cases (35%) compared with one case (2%) for pre-embolization DSA (2%) (P<0.0001). Of the cases in which the ICVs were seen preoperatively, in 15 cases (78.9%) the ICV drained directly into the VGM while in the other four cases, the ICV used alternative venous drainage routes. On post-operative MRV, the ICVs were seen in 17 cases (31%) on MRV and 10 cases (18.2%) on DSA with drainage into an adult-like vein of Galen in 13 cases (76%), respectively (P=0.08). In four cases normal ICV drainage into the vein of Galen was seen even when the venous sac was closed. In two cases there was a change in ICV drainage from the vein of Galen to the lateral mesencephalic vein.ConclusionThe communication of the ICV with the VGM is a common phenomenon. Different changes of venous drainage routes do occur after treatment and are best seen on MRV.

scholarly journals Posterior interhemispheric approach and microsurgical resection of a pineal parenchymal neoplasm of intermediate differentiation

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Anil Nanda ◽  
Subhas Konar ◽  
Piyush Kalakoti ◽  
Tanmoy Maiti
Keyword(s):  
Rare Tumor ◽  
Venous Anatomy ◽  
Link Type ◽  
Tumor Pathology ◽  
Interhemispheric Approach ◽  
Histological Variant ◽  
Microsurgical Resection ◽  
Gait Disturbances ◽  
Caucasian Female

Owing to a deep-seated location and intricate venous anatomy, pathologies of the posterior third ventricular region pose formidable challenges to the operating neurosurgeon. In this video, we present a case of an elderly Caucasian female with a rare histological variant of a pineal parenchymal mass who presented with gait disturbances and worsening retro-orbital headache. Radiological and clinco-histopathological correlates of this rare tumor pathology having intermediate differentiation are highlighted. Briefly outlined are surgical pearls and strategies to minimize complications, as the tumor is approached through the posterior interhemispheric corridor, to achieve a gross-total decompression.The video can be found here: https://youtu.be/KXwclZ7Ei84.

Internal cerebral veins varix due to midline arteriovenous malformation: how much is the risk of bleeding?

2011 ◽  
Vol 32 (6) ◽  
pp. 1253-1254 ◽  
Author(s):  
Carmelo Lucio Sturiale ◽  
Alfredo Puca ◽  
Alessio Albanese ◽  
Enrico Marchese ◽  
Giulio Maira
Keyword(s):  
Arteriovenous Malformation ◽  
Cerebral Veins ◽  
Risk Of Bleeding ◽  
Internal Cerebral Veins

scholarly journals Pregnancy Causes Diminished Myogenic Tone and Outward Hypotrophic Remodeling of the Cerebral Vein of Galen

2013 ◽  
Vol 33 (4) ◽  
pp. 542-542 ◽  
Author(s):  
Anne-Eva van der Wijk ◽  
Malou PH Schreurs ◽  
Marilyn J Cipolla
Keyword(s):  
Cerebral Arteries ◽  
Venous Blood ◽  
Blood Stasis ◽  
Wall Stress ◽  
Myogenic Tone ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen ◽  
First Time ◽  
Serotonergic Innervation

Pregnancy increases the risk of several complications associated with the cerebral veins, including thrombosis and hemorrhage. In contrast to the cerebral arteries and arterioles, few studies have focused on the effect of pregnancy on the cerebral venous side. Here, we investigated for the first time the effect of pregnancy on the function and structure of the cerebral vein of Galen in rats. Our major finding was that cerebral veins from late-pregnant (LP, n = 11) rats had larger lumen diameters and thinner walls than veins from nonpregnant (NP, n = 13) rats, indicating that pregnancy caused outward hypotrophic remodeling of the vein of Galen. Moreover, veins from NP animals had a small amount of myogenic tone at 10 mm Hg (3.9 ± 1.0%) that was diminished in veins during pregnancy (0.8 ± 0.3%; P < 0.01). However, endothelium-dependent and -independent vasodilation of the veins was unchanged during pregnancy. Using immunohistochemistry, we show that the vein of Galen receives perivascular innervation, and that serotonergic innervation of cerebral veins is significantly higher in veins from LP animals. Outward hypotrophic remodeling and diminished tone of cerebral veins during pregnancy may contribute to the development of venous pathology through elevated wall tension and wall stress, and possibly by promoting venous blood stasis.

Embryological basis of some aspects of cerebral vascular fistulas and malformations

1996 ◽  
Vol 85 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Sean Mullan ◽  
Saeid Mojtahedi ◽  
Douglas L. Johnson ◽  
R. Loch Macdonald
Keyword(s):  
Cavernous Sinus ◽  
Cerebral Vein ◽  
Cerebral Veins ◽  
Vein Of Galen Aneurysm ◽  
Content Type ◽  
Clinical Observations ◽  
Internal Cerebral Veins ◽  
Superior Petrosal Sinus ◽  
Frequent Absence ◽  
Frequent Failure

✓ The literature on the formation of cerebral veins is reviewed to obtain a better understanding of some cerebrovascular anomalies. Clinical observations such as the entry of the superior ophthalmic vein into the cavernous sinus through the inferior rather than the superior orbital fissure, the relative infrequency of middle cerebral vein backflow in the presence of an extensive cavernous fistula, and the relative infrequency of hemorrhage in relation to the inferior petrosal fistula all relate to the persistence of an older venous pathway. The frequent occurrence of hemorrhage in association with the superior petrosal sinus fistula and the frequent failure of the superior petrosal sinus to connect to the cavernous sinus similarly have an embryological explanation. The frequent association of the vein of Galen aneurysm and an absent or deformed straight sinus probably relates to the time at which the paired internal cerebral veins fuse into one channel. It is speculated that the origins of cerebral venous malformations (CVMs) and arteriovenous malformations (AVMs) probably relate to sequential formation and absorption of surface veins, which occur in human embryonic development mainly in the 40- to 80-mm length interval, although persistent AVM growth is possible even after birth. The frequent absence or anomaly of the middle cerebral vein and its failure to communicate with the cavernous sinus in the presence of both CVMs and AVMs are linked to the late development of that vein and to its even later connection to the cavernous sinus.

Surgical management of pineal region lesions

2019 ◽  
pp. 439-446
Author(s):  
Christoph M. Woernle ◽  
René L. Bernays ◽  
Nicolas de Tribolet
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Internal Cerebral Veins ◽  
Supracerebellar Infratentorial Approach ◽  
Occipital Transtentorial Approach ◽  
Basal Vein Of Rosenthal ◽  
Third Ventricle Tumours ◽  
Quadrigeminal Plate ◽  
The Brain

Lesions in the pineal region are topographically located in the centre of the brain in the diencephalic-epithalamic region. An area where the brain is bounded ventrally by the quadrigeminal plate, midbrain tectum, and in-between the left and right superior colliculi, dorsally by the splenium of the corpus callosum, caudally by the cerebellar vermis and rostrally by the posterior aspects of the third ventricle. Major anatomical and surgical challenges are the vein of Galen located dorsally, the precentral cerebellar vein caudally, the internal cerebral veins anteriorly and the basal vein of Rosenthal laterally. Most pineal region tumours can be safely removed by both approaches depending on the surgeon’s experience: the occipital transtentorial approach is recommended in presence of associated hydrocephalus or a steep straight sinus and low location of the tumour and the supracerebellar infratentorial approach for posterior third ventricle tumours.

Spontaneous Resolution of Cavum Veli Interpositi

2008 ◽  
Vol 21 (6) ◽  
pp. 805-809
Author(s):  
S. Vattoth ◽  
Y.S. Kim ◽  
E. Norman ◽  
G.H. Roberson
Keyword(s):  
Case Reports ◽  
Third Ventricle ◽  
Septum Pellucidum ◽  
Spontaneous Resolution ◽  
Cerebral Veins ◽  
Cavum Septum Pellucidum ◽  
Internal Cerebral Veins ◽  
Cavum Veli Interpositi ◽  
Quadrigeminal Plate ◽  
Forward Extension

Cavum veli interpositi is an open CSF space in the roof of the third ventricle that surrounds the internal cerebral veins, and is a forward extension of the quadrigeminal plate cistern. To the best of our knowledge, spontaneous resolution of a cavum veli interpositi has not been reported in the literature to date. Interestingly, case reports of spontaneous resolution of cystic cavum septum pellucidum in three patients and eighteen arachnoid cyst cases has been described in the literature. We describe the spontaneous resolution of a cavum veli interpositi or cyst in cavum veli interpositi in a 35-year-old man and review the literature of spontaneous resolution of cavum septum pellucidum and arachnoid cysts.

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