Virtual Reality Surgical Rehearsal and 2-Dimensional Operative Video of a Paramedian Supracerebellar Infratentorial Approach Endoscopic Resection of Pineocytoma: 2-Dimensional Operative Video

2020 ◽  
Vol 20 (1) ◽  
pp. E51-E52
Author(s):  
Walter C Jean
Keyword(s):  
Virtual Reality ◽  
Solid Tumors ◽  
Endoscopic Resection ◽  
Pineal Region ◽  
Histopathological Diagnosis ◽  
Pineal Tumor ◽  
Cerebral Veins ◽  
Patient Consent ◽  
Surgical Corridor ◽  
Keyhole Approach

Abstract An endoscopic “keyhole” approach to a deep-lying skull base lesion can be a daunting challenge. For the pineal region, the techniques for endoscopic resection of solid tumors in this location are also new.1,2 In such a situation, surgical rehearsal in virtual reality (VR) can significantly improve the surgeon's confidence.3 In this operative video, we demonstrate the use of VR in surgical planning and rehearsal to determine the best approach to a large, solid pineal tumor in a 46-yr-old patient. Using the patient's computed tomography angiography and magnetic resonance imaging, a VR model of his anatomy was created (SNAP VR360 version 3.8.0, Surgical Theater Inc, Cleveland, Ohio). VR rehearsal showed that, with the tumor tucked under the corpus callosum and cradled by the internal cerebral veins and veins of Rosenthal, a supratentorial approach would be suboptimal. Because of the steep angle of the patient's tentorium in the midline, a classic supracerebellar infratentorial (SCIT) approach would be challenging, and thus a paramedian variant of SCIT was chosen.4 For a right-handed surgeon, the left side was used, and the endoscope was docked at the extreme left, out of the main surgical corridor. Shown in the video, the endoscopic resection achieved a complete resection. The histopathological diagnosis was a pineocytoma. No adjuvant treatment is recommended. Given the rarity of pineocytoma,5 the novelty of endoscopic resection of solid tumors in the region, and the challenge of “keyhole” approaches to deep-lying targets, VR rehearsal facilitated the achievement of the surgical goal and avoided the morbidity of a more extensive exposure. Patient consent was obtained prior to the creation of the video and available on request. RHOTON images in the video are from The Rhoton Collection®.

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.

Anterior interhemispheric transsplenial approach to pineal region tumors: anatomical study and illustrative case

2018 ◽  
Vol 128 (1) ◽  
pp. 182-192 ◽  
Author(s):  
Kaan Yağmurlu ◽  
Hasan A. Zaidi ◽  
M. Yashar S. Kalani ◽  
Albert L. Rhoton ◽  
Mark C. Preul ◽  
...  
Keyword(s):  
Corpus Callosum ◽  
Anatomical Study ◽  
Pineal Region ◽  
Venous System ◽  
Illustrative Case ◽  
Cerebral Veins ◽  
Pineal Region Tumors ◽  
Deep Venous System ◽  
Surgical Corridor ◽  
Occipital Lobes

Pineal region tumors are challenging to access because they are centrally located within the calvaria and surrounded by critical neurovascular structures. The goal of this work is to describe a new surgical trajectory, the anterior interhemispheric transsplenial approach, to the pineal region and falcotentorial junction area. To demonstrate this approach, the authors examined 7 adult formalin-fixed silicone-injected cadaveric heads and 2 fresh human brain specimens. One representative case of falcotentorial meningioma treated through an anterior interhemispheric transsplenial approach is also described. Among the interhemispheric approaches to the pineal region, the anterior interhemispheric transsplenial approach has several advantages. 1) There are few or no bridging veins at the level of the pericoronal suture. 2) The parietal and occipital lobes are not retracted, which reduces the chances of approach-related morbidity, especially in the dominant hemisphere. 3) The risk of damage to the deep venous structures is low because the tumor surface reached first is relatively vein free. 4) The internal cerebral veins can be manipulated and dissected away laterally through the anterior interhemispheric route but not via the posterior interhemispheric route. 5) Early control of medial posterior choroidal arteries is obtained. The anterior interhemispheric transsplenial approach provides a safe and effective surgical corridor for patients with supratentorial pineal region tumors that 1) extend superiorly, involve the splenium of the corpus callosum, and push the deep venous system in a posterosuperior or an anteroinferior direction; 2) are tentorial and displace the deep venous system inferiorly; or 3) originate from the splenium of the corpus callosum.

scholarly journals Posterior interhemispheric transtentorial approach for resection of a meningioma at the posteromedial tentorial incisura

2016 ◽  
Vol 40 (videosuppl1) ◽  
pp. 1 ◽  
Author(s):  
Sun Liyong ◽  
Yuhai Bao ◽  
Jiantao Liang ◽  
Mingchu Li ◽  
Jian Ren
Keyword(s):  
Third Ventricle ◽  
Symptomatic Improvement ◽  
Pineal Region ◽  
Increased Intracranial Pressure ◽  
Total Removal ◽  
Adjacent Structures ◽  
Patient Reported ◽  
Surgical Corridor ◽  
Tentorial Incisura ◽  
Transtentorial Approach

The posterior interhemispheric approach is a versatile approach to access lesions of the pineal region, posterior incisural space, posterior region of third ventricle, and adjacent structures. We demonstrate the case of a 26-year-old woman with symptoms of increased intracranial pressure and hydrocephalus caused by a meningioma at the posteromedial tentorial incisura. Gross-total removal of the tumor was successfully achieved via a posterior interhemispheric transtentorial approach. The patient reported an immediate and significant symptomatic improvement after surgery. The detailed operative technique and surgical nuances, including the surgical corridor, tentorium incision, tumor dissection and removal are illustrated in this video atlas.The video can be found here: https://youtu.be/nSNyjQKl7aE.

scholarly journals Neuroendoscopic resection of posterior third ventricular ependymoma

2005 ◽  
Vol 18 (6) ◽  
pp. 1-2 ◽  
Author(s):  
Neal Luther ◽  
Mark M. Souweidane
Keyword(s):  
Radiation Therapy ◽  
Solid Tumors ◽  
Endoscopic Resection ◽  
Adjuvant Radiation ◽  
Radiographic Evidence ◽  
Adjuvant Radiation Therapy ◽  
Cystic Tumors ◽  
Intraventricular Tumors ◽  
Definitive Management

✓ The practice of neuroendoscopy in the definitive management of cystic tumors and hydrocephalus has been well established. Resection of solid intraventricular tumors by a primary endoscopic technique, however, has rarely been demonstrated. The authors present the case of a 31-year-old woman in whom endoscopic resection of a posterior third ventricular ependymoma was successfully accomplished. Metastatic workup yielded no sites of dissemination, adjuvant radiation therapy was deferred, and the patient has been without radiographic evidence of disease after 6 months of follow up. Endoscopic resection of solid tumors appears feasible in select patients and warrants further evaluation.

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: MR Signal Intensity Correlated to Histopathology

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Marcos Rosa Junior ◽  
Antonio Jose da Rocha ◽  
Adriano Zanon da Silva ◽  
Sergio Rosemberg
Keyword(s):  
Subcommissural Organ ◽  
Pineal Region ◽  
World Health ◽  
Pineal Tumor ◽  
Imaging Diagnosis ◽  
Posterior Commissure ◽  
Papillary Tumor ◽  
The World ◽  
T1 Hyperintensity ◽  
Health Organization

Tumors of the pineal region are rare and can be challenging to differentiate by imaging. Papillary tumor of the pineal region (PTPR) was recently recognized as a neoplasm in the World Health Organization (WHO) 2007 classification, arising from specialized ependymocytes in the subcommissural organ, which is located in the pineal region. It is a rare histological type of pineal tumor with only a few cases reported. Here, we describe a case of histologically confirmed PTPR in a 17-year-old man who presented with a headache. A literature review was performed to clarify the clinical, radiological, and pathological features of PTPR. Pineal neoplasms do not have pathognomonic imaging findings; however, we discuss T1 hyperintensity, which is a key for imaging diagnosis according to recent reports. In particular, if the hyperintensity in T1 is not due to fat, calcification, melanin, or hemorrhage in a mass of the posterior commissure or pineal region, the diagnosis of a PTPR may be suggested, as observed in this case.

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 Supraorbital transciliary keyhole approach for removal of tuberculum sellae meningioma: 3D surgical video

2021 ◽  
Vol 12 ◽  
pp. 5
Author(s):  
J. Javier Cuellar-Hernandez ◽  
J. Ramon Olivas-Campos ◽  
Paulo M. Tabera-Tarello ◽  
Miracle Anokwute ◽  
Alan Valadez-Rodriguez
Keyword(s):  
Visual Field ◽  
Tumor Resection ◽  
Visual Fields ◽  
Optic Nerves ◽  
Tuberculum Sellae Meningioma ◽  
Primary Indication ◽  
Tuberculum Sellae ◽  
Surgical Corridor ◽  
Keyhole Approach ◽  
Supraorbital Craniotomy

Background: Tuberculum sellae meningiomas have an incidence from 5 to 10% of all intracranial meningiomas[2] and tend to be surgically difficult and challenging tumors given their proximity to important structures such as the internal carotid artery (ICA), anterior cerebral artery (ACA), and optic nerves.[3] Typically, their growth is posteriorly and superiorly oriented, thereby displacing the optic nerves and causing visual dysfunction, which is the primary indication for surgical treatment.[1] The main goals of the treatment are the preservation or restoration of visual abilities and a complete tumor resection.[1] Conventionally, surgical approaches to tuberculum meningiomas involve largely invasive extended bifrontal, interhemispheric, orbitozygomatic, pterional, and subfrontal eyebrow approaches. The supraorbital craniotomy, however, is a minimally invasive transcranial approach that offers a similar surgical corridor to conventional transcranial approaches, using a limited craniotomy and minimal brain retraction that can be used for tumoral and vascular pathologies,[4,5] offering added cosmetic outcomes.[1] We present the case of a patient undergoing a supraorbital transciliary craniotomy with a tuberculum sellae meningioma causing bitemporal hemianopsia. Case Description: A 70-year-old female with chronic headaches and progressive vision loss and visual field deficit for about 1 year. On ophthalmological evaluation, she was able to fixate and follow objects with each eye, light perception was only present in the right eye, and the vision in the left eye was 0.2 decimal units. Her visual fields demonstrated severe campimetric deficits. Her extraocular movements were intact and bilateral pupils were equal, round, and reactive to light. MRI of the brain demonstrated tuberculum sellae meningioma with bilateral optic canal invasion, displacing the chiasm, and extending ≥180° around the medial ICA wall and anterior ACA wall. The patient underwent supraorbital transciliary keyhole approach for total resection of the tumor. Postoperatively, visual acuity and visual field were significantly improved. Conclusion: Performing a supraorbital transciliary keyhole craniotomy for tuberculum sellae meningiomas requires an adequate and meticulous preoperative planning to determine the optimal surgical corridor to the lesion. The use of supraorbital craniotomy is safe with good cosmetic results and potentially lower morbidity allowing for adequate exposure, resection, and release of neurovascular structures.

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.

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