scholarly journals Resection of a pineal region papillary tumor using robotic exoscope: improved visualization and ergonomics for deep seeded tumor

2021 ◽  
Vol 5 (1) ◽  
pp. V14
Author(s):  
Wei X. Huff ◽  
Andrew J. Witten ◽  
Mitesh V. Shah
Keyword(s):  
Marked Improvement ◽  
Pineal Region ◽  
Operating Microscope ◽  
High Definition ◽  
Papillary Tumor ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Close Proximity ◽  
Supracerebellar Infratentorial Approach ◽  
Deep Location

Surgery for pineal region tumors is technically challenging due to their deep location and close proximity to critical deep venous structures, midbrain, and thalamus. A high-definition video exoscope was recently proposed as an alternative to the operating microscope. The authors illustrate a case of the midline supracerebellar infratentorial approach to resect a pineal region tumor using the Modus V exoscope and demonstrate the improved visualization of critical structures in this deep location. Additionally, the marked improvement in surgeon comfort suggests that this system may have significant advantages over traditional microscope-based surgery for tumors of the pineal region. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2127.

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.

Microsurgical Resection of Posterior Third Ventricular/Pineal Region Papillary Tumor Via Supracerebellar Infratentorial Approach: 3-Dimensional Operative Video

2018 ◽  
Vol 15 (6) ◽  
pp. E87-E87
Author(s):  
Sima Sayyahmelli ◽  
Ihsan Dogan ◽  
Mustafa K Başkaya
Keyword(s):  
Third Ventricle ◽  
Pineal Region ◽  
Direct Access ◽  
Third Ventriculostomy ◽  
Papillary Tumor ◽  
Pineal Region Tumor ◽  
3 Dimensional ◽  
History Of ◽  
Supracerebellar Infratentorial Approach ◽  
Microsurgical Resection

Abstract The posterior third ventricle and pineal region can harbor different pathologies. The supracerebellar infratentorial approach allows a direct access to the pineal region and posterior third ventricle and provides wide exposure of the arachnoid planes and deep venous system.  In this 3-dimensional video, we present a patient with posterior third ventricular/pineal region tumor who underwent microsurgical resection via supracerebellar infratentorial approach. The patient is a 28-year-old woman with history of hydrocephalus who underwent endoscopic third ventriculostomy and biopsy at an outside hospital. The histopatology of the tumor was papillary tumor of the pineal region. The patient was referred for further surgical resection due to enlargement of her tumor on follow-up radiological imaging. The surgery and the patient's postoperative course were uneventful and the patient remained unchanged in the postoperative period.  The important steps of the surgical approach and microsurgical resection are demonstrated in this 3-dimensional surgical video. The patient consented to publication of her images.

scholarly journals Papillary tumor of the pineal region

2017 ◽  
Vol 4 (12) ◽  
pp. 4076
Author(s):  
Murat Zaimoglu ◽  
Fatih Yakar ◽  
Ihsan Dogan ◽  
Yusuf Sukru Caglar
Keyword(s):  
Pineal Gland ◽  
Histopathological Examination ◽  
Pineal Region ◽  
Pineal Tumor ◽  
Intracranial Tumors ◽  
Surgical Experience ◽  
Recurrence Rates ◽  
Papillary Tumor ◽  
Pineal Region Tumors ◽  
Supracerebellar Infratentorial Approach

Pineal region tumors make up 0.4-1.0% of intracranial tumors in adults. These tumors may arise from pineal gland itself or structures around pineal gland which are all termed as pineal region tumors. Papillary tumor of the pineal region is a non-parenchymal tumor of the pineal region. It was first documented in 2003. We presented a 21 years old female patient with pineal tumor. Supracerebellar infratentorial approach was performed. The total excision of the lesion was achieved successfully. Histopathological examination revealed papillary tumor of the pineal region. The case is discussed in the light of our preoperative surgical experience, its pre-and post-operative radiological and histopathological evaluation. Supracerebellar infratentorial approach is encountered as the favoured approach generally. As recurrence rates are high, adjuvant treatment is advised after surgery. Further research on this pathology will enlighten the neurosurgeons for effective treatment.

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.

scholarly journals Papillary tumor of the pineal region in a 15-month-old boy

2011 ◽  
Vol 7 (5) ◽  
pp. 534-538 ◽  
Author(s):  
Jessica Li ◽  
Pablo F. Recinos ◽  
Brent A. Orr ◽  
Peter C. Burger ◽  
George I. Jallo ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Proton Beam Therapy ◽  
Pineal Region ◽  
Biological Behavior ◽  
Imaging Diagnosis ◽  
Papillary Tumor ◽  
Distinct Entity ◽  
Pineal Region Tumor ◽  
Appropriate Treatment

The papillary tumor of the pineal region (PTPR) is a distinct entity that is particularly rare in the pediatric population. The authors document the youngest reported patient with this clinicopathological entity to date. A case of PTPR in a 15-month-old boy is described. Initially thought to be a tectal glioma, the tumor was later identified as a pineal region tumor after demonstrating growth on routine imaging. Diagnosis of PTPR was established by histopathological evaluation of biopsy samples, which revealed papillary, cystic, and solid tumor components. The patient's postoperative course was complicated by tumor growth despite several debulking procedures and chemotherapy, as well as persistent hydrocephalus requiring 2 endoscopic third ventriculostomies and eventual ventriculoperitoneal shunt placement. After a 15-month follow-up period, the patient has received proton-beam therapy and has a stable tumor size. The PTPR is a recently described tumor of the CNS that must be included in the differential diagnosis of pineal region masses. The biological behavior, prognosis, and appropriate treatment of PTPR have yet to be fully defined.

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 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.

scholarly journals Meningioma of the Pineal Region — Differential Radiologic Aspects of Pineal Region Tumors Based on a Clinical Case

2018 ◽  
Vol 37 (02) ◽  
pp. 145-147
Author(s):  
Tiago Avelar ◽  
Aline Paiva ◽  
Márcio Costa ◽  
Guilherme Aguiar ◽  
João Vitorino ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Clinical Case ◽  
Pineal Region ◽  
Differential Diagnoses ◽  
Benign Lesions ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
The Central Nervous System ◽  
Velum Interpositum

AbstractPineal region tumors are uncommon among neoplasm of the central nervous system, with this region being the most heterogeneous in terms of histological types. Meningiomas are rarer still, but can be found at this site, with origins in either the velum interpositum or falcotentorial junction. Neuroimaging exams can distinguish malignant from benign lesions besides helping to define the origin of the lesion as the pineal parenchymal or surrounding structures. We report the case of a woman with a pineal region tumor in which differential diagnoses included meningioma and germinoma, with confirmation of the former based on radiological characteristics and histopathology. In addition, a brief review of differential diagnoses and approaches for cases of lesions in this region is provided.

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