Surgical Treatment of Pineal Region Tumours Through the Occipital Transtentorial Approach: Evaluation of the Effectiveness of Intra-Operative Micro-Endoscopy Combined with Neuronavigation

1999 ◽  
Vol 141 (8) ◽  
pp. 801-809 ◽  
Author(s):  
R. Shirane ◽  
H. Shamoto ◽  
K. Umezawa ◽  
C.-C. Su ◽  
T. Kumabe ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Pineal Region ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach ◽  
Pineal Region Tumours

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 Right occipital transtentorial approach for a pineal malignant germ cell tumor

2021 ◽  
Vol 5 (1) ◽  
pp. V3
Author(s):  
Brian J. A. Gill ◽  
Dominique M. Higgins ◽  
Matei A. Banu ◽  
Michael G. Argenziano ◽  
Neil A. Feldstein ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Pineal Region ◽  
First Line ◽  
Intracranial Germ Cell Tumors ◽  
Somatic Transformation ◽  
Malignant Germ Cell Tumor ◽  
Occipital Transtentorial Approach ◽  
Malignant Lesions ◽  
Transtentorial Approach

Germ cell tumors account for up to 53% of the malignant lesions found in the pineal region and are typically managed with a combination of radiation therapy and chemotherapy. Malignant somatic transformation of intracranial germ cell tumors is exceedingly rare and has only been reported on two other occasions. Here the authors present the case of a pineal yolk sac tumor that failed optimum first-line treatment and underwent malignant somatic transformation to an enteric mucinous adenocarcinoma requiring surgical intervention. This video demonstrates the technical nuances of the occipital transtentorial approach and the safe microsurgical dissection of lesions within the pineal region. The video can be found here: https://stream.cadmore.media/r10.3171/2021.4.FOCVID2151.

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

scholarly journals Retractorless surgery for a pineal region tumor through an occipital transtentorial approach

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1
Author(s):  
Naoyuki Nakao
Keyword(s):  
Visual Cortex ◽  
Tissue Injury ◽  
Obstructive Hydrocephalus ◽  
Surgical Techniques ◽  
Pineal Region ◽  
Pineal Region Tumor ◽  
Working Space ◽  
Occipital Transtentorial Approach ◽  
The Brain ◽  
Transtentorial Approach

This video demonstrates surgical techniques of the occipital transtentorial approach to a pineal region tumor without using a fixed brain retractor, which may cause functional impairment or even tissue injury to the occipital visual cortex. There are several ways to facilitate retractorless surgery through this approach. A lateral-semiprone positioning of the patient can induce gravity retraction. The brain is relaxed by draining CSF fluid through lumbar drainage or lateral ventricular tap in the case of obstructive hydrocephalus. Dynamic retraction with handheld instruments after extensive dissection of the deep venous system, including basal veins, can provide a sufficient working space.The video can be found here: https://youtu.be/kQvEHiNcRow.

Comparison of Posterior Approaches to the Posterior Incisural Space: Microsurgical Anatomy and Proposal of a New Method, the Occipital Bi-transtentorial/Falcine Approach

Neurosurgery ◽  
2002 ◽  
Vol 51 (5) ◽  
pp. 1208-1221 ◽  
Author(s):  
Masatou Kawashima ◽  
Albert L. Rhoton ◽  
Toshio Matsushima
Keyword(s):  
Pineal Region ◽  
New Method ◽  
Surgical Approaches ◽  
Microsurgical Anatomy ◽  
New Approach ◽  
Quadrigeminal Cistern ◽  
Occipital Transtentorial Approach ◽  
Arteries And Veins ◽  
Lateral Walls ◽  
Transtentorial Approach

Abstract OBJECTIVE Direct surgical approaches to the posterior incisural space, including the pineal region, remain as challenges for neurosurgeons. The purposes of this study were 1) to compare the surgical views in the various posterior approaches to the posterior incisural space and 2) to propose a new approach, which is a modification of the occipital transtentorial approach. METHODS Ten adult cadaveric specimens (20 sides) were studied, using ×3 to ×40 magnification, after perfusion of the arteries and veins with colored silicone. Intraoperative views in the posterior approaches to lesions were examined in stepwise dissections. In addition, the efficacy of the occipital bi-transtentorial/falcine approach was studied. RESULTS The posterior incisural space has a roof, a floor, and anterior and lateral walls and extends backward to the level of the tentorial apex. The operative views defined by each approach differ in the extent to which they allow observation of the anatomic structures in the posterior incisural space. The occipital bi-transtentorial/falcine approach permits better observation of the contralateral half of the quadrigeminal cistern. CONCLUSION Precise surgical anatomic knowledge of each approach is required for the treatment of lesions in the posterior incisural space, because the operative fields obtained with different approaches differ significantly. The occipital bi-transtentorial/falcine approach provides greater contralateral exposure of the posterior incisural space than does the occipital transtentorial approach.

scholarly journals Pineal epidermoid cysts: diagnosis and management

1999 ◽  
Vol 91 (3) ◽  
pp. 370-374 ◽  
Author(s):  
Alexander Nikolaevich Konovalov ◽  
Aldo Spallone ◽  
David Ilich Pitzkhelauri
Keyword(s):  
Clinical History ◽  
Pineal Region ◽  
Diagnostic Tools ◽  
Resonance Imaging ◽  
Content Type ◽  
Epidermoid Cysts ◽  
Pupillary Reaction ◽  
Occipital Transtentorial Approach ◽  
Transtentorial Approach ◽  
Fine Print

Object. The results of surgical treatment of epidermoid cysts of the pineal region in six cases are presented.Methods. Six patients with pineal epidermoid cysts underwent surgery at the Institute of Neurosurgery “N. N. Burdenko,” in Moscow, during the period 1976 to 1995. The duration of the patients' preadmission clinical history varied from 6 months to 2 years (average 1.4 years). Headache, diplopia, and vertigo were the most frequently occurring symptoms. Neurological examination demonstrated papilledema, impaired pupillary reaction, ataxia, and long-pathways deficit; Parinaud's syndrome was found in only one case. Computerized tomography and magnetic resonance imaging constituted the primary diagnostic tools. Surgery was performed using either an infratentorial—supracerebellar approach (two cases) or an occipital—transtentorial approach (four cases).Conclusions. Surgical results can be excellent if a removal, as extensive as possible, is performed using either the supracerebellar or occipital—transtentorial approach.

scholarly journals Pineal region chordoid meningioma

2018 ◽  
Vol 24 (2) ◽  
pp. 148-152
Author(s):  
Felipe Salviero ◽  
Cláuder Ramalho ◽  
João Noberto Stavale ◽  
Sérgio Cavalheiro ◽  
Manoel Antônio De Paiva Neto
Keyword(s):  
Histological Analysis ◽  
Clinical Presentation ◽  
Pineal Region ◽  
Chordoid Meningioma ◽  
Pineal Region Tumor ◽  
Pineal Region Tumors ◽  
Ophthalmologic Examination ◽  
Occipital Transtentorial Approach ◽  
Vertical Gaze ◽  
Transtentorial Approach

Background: Meningiomas correspond to only 8% of pineal region tumors. Chordoid meningioma (CM) comprises only 0.5 to 1.0% of all intracranial meningiomas and is even rarer in the pineal region. In the literature, we found only six cases of pineal region CMs reported. Clinical presentation: We describe a case of one patient with headache, confusion, slurred speech and gait disturbance. The ophthalmologic examination revealed vertical gaze paresis and near-light dissociation of papillary reflex. MRI disclosed a large pineal region tumor with heterogeneous contrast enhancement. The tumor was totally removed by an occipital transtentorial approach (OTA) in a “three-quarter prone” position. Histological analysis disclosed a CM. Conclusion: Chordoid meningioma is a very rare variant of meningioma and the pineal region is a poorly described site. This study contributes to the understanding of this heterogeneous entity, to consider the CM as a differential diagnosis of pineal region tumors and to provide proper management of affected patients.

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