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.

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.

scholarly journals Resection of a recurrent pineal region teratoma via a posterior interhemispheric transcallosal approach

2021 ◽  
Vol 5 (1) ◽  
pp. V13
Author(s):  
David S. Hersh ◽  
Scott Boop ◽  
Frederick A. Boop
Keyword(s):  
Unusual Case ◽  
Mature Teratoma ◽  
Pineal Region ◽  
Cerebral Veins ◽  
Total Resection ◽  
Transcallosal Approach ◽  
Initial Surgery ◽  
Internal Cerebral Veins ◽  
Interhemispheric Fissure ◽  
Complex Lesions

The authors describe the unusual case of a 6-year-old boy presenting with decorticate posturing, diminished hearing, and an inability to open his eyes, despite being verbally responsive. He underwent a posterior interhemispheric transcallosal intervenous approach for resection of a pineal region mature teratoma, which recurred 2 years postoperatively. This video demonstrates his initial surgery and reresection, illustrating the value of this approach for more complex lesions that involve the internal cerebral veins (ICVs). At the time of recurrence, microsurgical dissection of the scarred interhemispheric fissure was required to facilitate removal of the multifocal recurrent teratoma, resulting in gross-total resection. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2134.

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.

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.

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.

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.

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 Surgical approaches to the third ventricle of the brain in children

2021 ◽  
Vol 11 (1) ◽  
pp. 47-54
Author(s):  
Sergey K. Gorelyshev ◽  
Olga A. Medvedeva
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Anterior Horn ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
The Third ◽  
Lateral Ventricles ◽  
The Brain

AIM: This study aimed to describe and analyze the advantages and disadvantages of various surgical approaches to neoplasms of the third ventricle of the brain in children. MATERIALS AND METHODS: This study analyzed surgical interventions to the third ventricle in 657 patients, performed at the Academician N.N. Burdenko of the Research Institute of Neurosurgery from 1998 to 2018. These included 375 patients with intra-extraventricular craniopharyngiomas and 282 patients with gliomas of the third ventricle and chiasm. The patients age ranged from 3 mon to 18 years old. RESULTS: The anterior transcallosal approach provides access to the anterior horn and bodies of the lateral ventricles, as well as the third ventricle. The transfornical approach provides more opportunities for access to both the anterior and posterior parts of the third ventricle; however, it has a high risk of trauma to the fornix. The subchoroidal approach provides a very good view of the posterior parts of the third ventricle, especially of the pineal region; however, it has even greater restrictions on viewing its anterior parts. When compared with the transcallosal approach, the transfrontal approach can be used more safely in the absence of hydrocephalus (if the tumor is located in the anterior horn). No specific complications were inherent in a particular approach (seizures were registered in 1%, transient hemiparesis was noted in 10%, and transient memory impairments were revealed in 5% of cases). CONCLUSION: The use of a transcallosal approach is safe even in infants. The transcortical approach is recommended mainly for large tumors of the lateral ventricles, and the transcallosal approach should be used for small tumors of the third ventricle. No specific complications were inherent in a particular approach, and the choice was determined by the assessment of the exact location of the tumor and calculation of the most relevant trajectory for its achievement as well as the aim (biopsy or radical removal). Analysis of magnetic resonance imaging and neuronavigation are significant in the selection of surgical approaches.

The Posterior Transcallosal Approach to the Pineal Region and Posterior Third Ventricle: Intervenous and Paravenous Variants

2016 ◽  
Vol 13 (1) ◽  
pp. 77-88 ◽  
Author(s):  
Prayash G. Patel ◽  
Aaron A. Cohen-Gadol ◽  
Philippe Mercier ◽  
Frederick A. Boop ◽  
Paul Klimo
Keyword(s):  
Third Ventricle ◽  
Signs And Symptoms ◽  
Pineal Region ◽  
Neurological Deficits ◽  
Surgical Approaches ◽  
Cerebral Vein ◽  
Tumor Type ◽  
Transcallosal Approach ◽  
Advantages And Disadvantages ◽  
Local Progression

Abstract BACKGROUND: There are a number of surgical approaches to the posterior third ventricle and pineal region, each with its associated advantages and disadvantages. OBJECTIVE: To present our experience with the posterior interhemispheric transcallosal approach and to analyze the indications, technique, and outcomes. METHODS: A retrospective study was conducted to identify and analyze all children and young adults who underwent the posterior transcallosal approach from July 2010 to March 2015. Perioperative data included patient demographics, signs and symptoms on presentation, tumor characteristics (type, origin, and size), complications, and clinical and radiographic outcome at final follow-up. RESULTS: Twenty-two patients (9 female, 13 male) were identified in 24 cases with a mean age of 10.5 years (range, 3-32 years). The most common tumor type was pineoblastoma (n = 6). Eleven patients underwent gross total resections; 11 underwent subtotal resections; and 2 tumors were biopsied. The intervenous operative corridor was used in 15 cases; the paravenous was used in 9. Of the 22 patients, 19 experienced 31 total postoperative events. There were 12 instances of contralateral weakness. Retraction-related hemiparesis was usually temporary; resection-related hemiparesis lasted longer. There were no complications related to occlusion of one or more bridging cortical veins or from thrombosis of 1 internal cerebral vein. Eight patients have died of tumor progression, and of the remaining 14 patients, only 1 patient to date has developed local progression. CONCLUSION: The posterior interhemispheric transcallosal approach allows resection of tumors located within the pineal region, posterior third ventricle, and thalamus. New postoperative neurological deficits can occur; however, many will improve significantly or resolve completely over time.

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