scholarly journals Posterior interhemispheric occipital transtentorial approach for resection of a falcotentorial meningioma

2021 ◽  
Vol 5 (1) ◽  
pp. V2
Author(s):  
Visish M. Srinivasan ◽  
Joshua S. Catapano ◽  
John P. Sheehy ◽  
Mohamed A. Labib ◽  
Michael T. Lawton
Keyword(s):  
Neurological Examination ◽  
Cerebral Veins ◽  
Radiographic Evidence ◽  
Falx Cerebri ◽  
Tentorium Cerebelli ◽  
Simpson Grade ◽  
Internal Cerebral Veins ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach

Falcotentorial meningiomas arise along the junction of the falx cerebri and the tentorium cerebelli. The authors present a woman in her 60s with an incidentally discovered falcotentorial meningioma, approximately 3 cm in diameter, resected with a torcular craniotomy and posterior interhemispheric approach. The galenic complex was dissected away from the tumor. In the final view, the bilateral internal cerebral veins and basal veins of Rosenthal were seen. A Simpson grade I resection was achieved. The patient experienced transient contralateral hemianopsia and was discharged home. At 1-year follow-up, her neurological examination findings were unremarkable, and there was no radiographic evidence of tumor. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2125.

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.

Abstract 3286: Persistently Reduced Venous Drainage After Intravenous Thrombolysis is Associated With Poor outcome in Acute Anterior Circulation Ischemic Stroke

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Leonard L Yeo ◽  
Ben Wakerley ◽  
Liang Shen ◽  
Aftab Ahmad ◽  
Kay W Ng ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Intravenous Thrombolysis ◽  
Venous Drainage ◽  
Cerebral Veins ◽  
Poor Functional Outcome ◽  
Anterior Circulation ◽  
Poor Outcome ◽  
Internal Cerebral Veins ◽  
Iv Tpa

Background- Significant numbers of acute ischemic stroke (AIS) patients recover with timely-administered intravenous tissue plasminogen activator (IV-TPA). However, rates and extent of recovery remain variable. Considering scarce and costly resources, early identification of reliable predictors for functional outcomes is important for planning rehabilitation strategies. We hypothesized that venous drainage would be impaired on the side of cerebral hypoperfusion due to acute occlusion of internal carotid or middle cerebral artery. The 2 internal cerebral veins (ICV) drain the deep parts of hemispheres and run backward to form great cerebral vein. Since ICVs are consistently seen on CT angiography (CTA), parallel and run very close to each other, even minor asymmetry in their filling can be easily diagnosed. ICV asymmetry in pre-TPA CTA can change in patients achieving arterial recanalization, rendering it less useful for predicting the long-term outcomes. Thus, we aimed at evaluating whether the presence of ICV asymmetry on follow-up CTA can predict the final outcome. Methods- Data from consecutive AIS patients treated with IV-TPA, in a standardized protocol, from Jan2007 to March2010 were included in a prospective registry at our tertiary center. In this study, we excluded posterior circulation strokes. Significant proportion AIS patients undergo CTA on day 2 after IV-TPA to assess the status of arterial patency. ICV asymmetry was assessed by 2 independent stroke neurologists/ neuroradiologists, blinded to patient data or outcomes. Functional outcomes were assessed by modified Rankin Scale (mRS) at 3-months, dichotomized as good outcome (mRS 0-1) and poor outcome (mRS 2-6). Data were analyzed for the early predictors of function outcome. Results- Of the total of 2238 patients admitted during the study period, 226 (10.1%) with anterior circulation AIS treated with intravenous thrombolysis were included. Median age was 65yrs (range 19-92), 63% males and median National Institute of Health Stroke Scale (NIHSS) 16points (range 4-32). Hypertension was the commonest vascular risk factor in 144 (76%) while 63 (33%) patients suffered from atrial fibrillation (AF). Overall, 108 (47.8%) patients achieved poor functional outcome at 3-months. ICV asymmetry could be assessed only in 103 (45.5%) patients on their follow up CTA films. Admission NIHSS score (OR1.08;95%CI 1.001-1.157,p=0.048) and ICV asymmetry on follow-up CT scan (OR 23.9;95%CI 5.15-63.99,p <0.0001) were associated with poor outcome at 3-months. Conclusion- Presence of the asymmetry of internal cerebral veins on the follow up CT angiography in acute ischemic stroke patients treated with IV-TPA can be used as an early predictor of poor functional outcome.

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.

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.

Occipital transtentorial/falcine approach, a “cross-court” trajectory to accessing contralateral posterior thalamic lesions: case report

2017 ◽  
Vol 127 (1) ◽  
pp. 165-170 ◽  
Author(s):  
Kenichiro Iwami ◽  
Masazumi Fujii ◽  
Kiyoshi Saito
Keyword(s):  
Cavernous Malformation ◽  
Occipital Lobe ◽  
Falx Cerebri ◽  
Posterior Thalamus ◽  
Occipital Transtentorial Approach ◽  
Left Thalamus ◽  
Surgical Field ◽  
Thalamic Lesions ◽  
Neurovascular Structures ◽  
Transtentorial Approach

Surgical treatment of lesions in the posterior thalamus, especially those extending laterally, is technically challenging because of a deep surgical field, narrow operative corridor, and the surrounding critical neurovascular structures. The authors describe an occipital transtentorial/falcine approach (OTFA) that was successfully used in the treatment of a cavernous malformation (CM) extending laterally from thalamus to midbrain. A 40-year-old man complained of progressive right hemiparesis and numbness. Radiological evaluation revealed a large CM in the left thalamus, surfacing on the pulvinar thalami, and extending 4 cm laterally from the midline. In addition to the usual procedures of a right-sided occipital transtentorial approach, the authors incised the falx cerebri to expand the operative corridor to the left thalamus. They achieved generous exposure of the left thalamus through a “cross-court” oblique trajectory while avoiding excessive retraction on the occipital lobe. The CM was completely removed, and no newly developed or worsening deficits were detected postoperatively. To better understand the OTFA and its application, the authors performed a cadaveric dissection. The OTFA provides increased exposure of the posterior thalamus without cortical incision and facilitates lateral access to this area through the “cross-court” operative corridor. This approach adds to the armamentarium for neurosurgeons treating thalamic lesions.

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 Meningiomas of pineal region in children

2007 ◽  
Vol 65 (4a) ◽  
pp. 1000-1006 ◽  
Author(s):  
Hamilton Matushita ◽  
Fernando Campos Pinto ◽  
José Píndaro Pereira Plese
Keyword(s):  
Clinical Presentation ◽  
Complete Removal ◽  
Pineal Region ◽  
Total Resection ◽  
Long Term Follow Up ◽  
One Year ◽  
Velum Interpositum ◽  
Transtentorial Approach

Meningiomas are uncommon tumors in children and either more rarely encountered in the pineal region. We report two cases of meningioma of the pineal region in children. One of these cases was a five years-old girl and the other a one year-old boy. No specific clinical presentation or tomographic examinations findings was identified before treatment, suggestive of a diagnosis of menigioma. The clinical and laboratory features were very similar to the most common tumors of the pineal region. Prior to the surgery, the histology of these tumors was not suspected. Both patients underwent direct surgery and complete removal was achieved by a suboccipital transtentorial approach. The tumors originated from velum interpositum in both cases. At the follow up, one case presented with recurrence six years later, and she underwent a reoperation with total resection without morbidity. Long-term follow up presented no other recurrences.

scholarly journals Long-term assessment of a modified tibial tuberosity advancement technique in dogs

2018 ◽  
Vol 70 (4) ◽  
pp. 1053-1059 ◽  
Author(s):  
R.M. Medeiros ◽  
M.A.M. Silva ◽  
P.P.M. Teixeira ◽  
D.G. Chung ◽  
M.E.B.A.M. Conceição ◽  
...  
Keyword(s):  
Gait Analysis ◽  
Positive Response ◽  
Tibial Tuberosity ◽  
Compression Tests ◽  
Radiographic Evidence ◽  
Long Term Follow Up

ABSTRACT The purpose of study was to assess long-term clinical and radiographic aspects of dogs’ stifle joints which had undergone a modified tibial tuberosity advancement technique (mTTA). A total of 15 stifles that had undergone mTTA for CCL disease of 11 patients were included in this study. Assessments involved patient’s gait analysis, cranial drawer and tibial compression tests, stifle goniometry range of articular motion, thigh and leg girth and radiographic evidence of progression of osteoarthrosis. Variables were compared between operated and healthy limbs and among moments (M0) on the early postop; (M1) 120 days postop; and (M2) approximately 5 years following surgery. A questionnaire regarding owner’s perceptions after approximately 5 years of surgery was assessed. Most dogs presented positive response to cranial drawer and tibial compression tests on operated knees. There was also decrease on goniometry and thigh girth and increase in leg girth. Radiographic evidence of progression of osteoarthritis was seen especially on the long-term follow-up (M2). On gait analysis, most animals presented some degree of lameness in different conditions, in contrast to owners’ perceptions. Osteoarthritis still develops in dogs following mTTA surgery for CCL disease. However, owners were overall satisfied with their recovery and would be willing to accept indication of mTTA for dogs with ruptured CCL.

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.

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