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Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note.

Felbaum D, Syed HR, Ryan JE, Jean WC, Anaizi A - Cureus (2016)

Bottom Line: A suboccipital craniectomy was performed in the sitting position.Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle.The patient was extubated and transferred to the intensive care unit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, Medstar Georgetown University Hospital.

ABSTRACT
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal resection of a traditionally difficult pineal region tumor. Further experience with this combined technique may allow for improved surgical outcomes for these complex lesions.

No MeSH data available.


Related in: MedlinePlus

Operative view through microscopeIntraoperative microscope-assisted photograph detailing the pineal tumor in the center and the deep venous structures surrounding the tumor.
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FIG4: Operative view through microscopeIntraoperative microscope-assisted photograph detailing the pineal tumor in the center and the deep venous structures surrounding the tumor.

Mentions: Written informed consent was obtained prior to surgery. After induction of adequate anesthesia, a central venous catheter and precordial Dopplers were placed. The patient’s central venous pressure was insured to be normal. The patient was placed in the sitting position in preparation for a supracerebellar infratentorial (SCIT) open microsurgical craniotomy (Figures 3, 4).


Endoscope-Assisted Combined Supracerebellar Infratentorial and Endoscopic Transventricular Approach to the Pineal Region: A Technical Note.

Felbaum D, Syed HR, Ryan JE, Jean WC, Anaizi A - Cureus (2016)

Operative view through microscopeIntraoperative microscope-assisted photograph detailing the pineal tumor in the center and the deep venous structures surrounding the tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4829397&req=5

FIG4: Operative view through microscopeIntraoperative microscope-assisted photograph detailing the pineal tumor in the center and the deep venous structures surrounding the tumor.
Mentions: Written informed consent was obtained prior to surgery. After induction of adequate anesthesia, a central venous catheter and precordial Dopplers were placed. The patient’s central venous pressure was insured to be normal. The patient was placed in the sitting position in preparation for a supracerebellar infratentorial (SCIT) open microsurgical craniotomy (Figures 3, 4).

Bottom Line: A suboccipital craniectomy was performed in the sitting position.Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle.The patient was extubated and transferred to the intensive care unit.

View Article: PubMed Central - HTML - PubMed

Affiliation: Neurosurgery, Medstar Georgetown University Hospital.

ABSTRACT
Neoplasms of the pineal region comprise less than 2% of all intracranial lesions. A variety of techniques have been adapted to gain access to the pineal region. Classic approaches employ the use of the microscope. More recently, the endoscope has been utilized to improve access to such deep-seated lesions. A 62-year-old female presented with a heterogeneously enhancing lesion in the pineal region with associated hydrocephalus. On exam, the patient exhibited Parinaud's syndrome. The patient initially underwent a single burr hole endoscopic third ventriculostomy and biopsy of the lesion. Initial pathology was consistent with a grade III astrocytoma. Following a period of recuperation, she returned for definitive surgical resection. A suboccipital craniectomy was performed in the sitting position. Prior to dural opening, an endoscope was inserted into the right lateral ventricle through the prior burr hole.The endoscope was passed through the foramen of Monro and the tumor could be visualized along the posterior third ventricle. The patient underwent a standard supracerebellar infratentorial approach aided by the microscope. After initial debulking of the pineal lesion, an endoscope was utilized to guide the depth of resection and assist in dissection with transventricular manipulation of the tumor. During the final stages of resection from the craniotomy, the endoscope was used to help visualize the posterior supracerebellar corridor. This assisted in the assessment of the extent of resection. The endoscope was also utilized for the removal of intraventricular blood products following tumor resection. The patient was extubated and transferred to the intensive care unit. A postoperative contrast-enhanced magnetic resonance imaging (MRI) revealed greater than 95% resection, with expected residual within the midbrain. The combined supracerebellar infratentorial and transventricular endoscope-assisted approach provided maximum visualization and aided in optimal resection of a traditionally difficult pineal region tumor. Further experience with this combined technique may allow for improved surgical outcomes for these complex lesions.

No MeSH data available.


Related in: MedlinePlus