Novel application of computer-assisted cisternal endoscopy for the biopsy of pineal region tumors: cadaveric study (original) (raw)
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Cureus, 2016
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.
Midline and off-midline infratentorial supracerebellar approaches to the pineal gland
Journal of Neurosurgery, 2016
S upracerebellar infratentorial approaches are commonly used for lesions involving the pineal gland. 1,6, 10,13,32 Although the midline route is frequently selected, there is the potential for several off-midline routes between the torcula medially and the asterion at the junction of the transverse and sigmoid sinuses laterally. The midline and off-midline routes differ with respect to depth and angle of approach, area of exposure, and risk to vascular structures along the approach. This study examined the microsurgical and endoscopic anatomy of the various infratentorial routes to the pineal gland, including midline, paramedian, lateral, and far-lateral supracerebellar ABBREVIATIONS CTA = CT angiography.
2011
P ineal region pathological entities may be accessed via a host of open microsurgical and endoscopic approaches. These include microsurgical openings such as the posterior interhemispheric transcallosal approach; 16,17 the supracerebellar infratentorial approach, with midline 52 and paramedian 63 variations; the transchoroidal approach through the atrium; the posterior trans-ventricular approach through the posterior portion of the lateral ventricle; 46 the combined supra-and infratentorial transsinus approach to large lesions; 65 and the occipital interhemispheric transtentorial approach. 32,44 Rigid or flexible endoscopic access to the pineal region may be achieved through the ventricle via the transforaminal transfrontal endoscopic approach from above, or alternatively via an endoscopic posterior fossa approach. 28,29
World Neurosurgery, 2020
The midline supracerebellar infratentorial (SCIT) approach and its paramedian development are commonly used for dealing with pineal lesions. However, comparative clinical studies are lacking. We aim to establish the better performance of the paramedian SCIT approach in terms of clinical safety in surgically treated pineal cysts and pineal region tumors. Procedural functionality and effectiveness have been also analyzed. Methods A comparative analysis of clinical, radiological, pathological, surgical features, and outcome was performed between 55 midline and 57 paramedian SCIT approaches that were exclusively performed in 112 patients (57 pineal cysts and 55 tumors of the pineal region) operated in sitting position by a single surgeon. Information was retrieved from hospital records and microsurgical videos. Results The paramedian SCIT approach linked with less postoperative complications (OR:0.40) and less approach-related complications (OR: 0.28) than the midline SCIT approach. The SCIT paramedian approach was achieved in a shorter time, by a smaller bone flap and less complex procedural steps than the midline approach. The SCIT paramedian approach did not require the opening of the falx cerebelli, midline cerebellar retraction, section of the midline cerebellar draining veins, nor wide opening of the dura. Gross total resection, size of the lesion, microsurgical time for removal, histopathological diagnosis and postoperative outcome were statistically similar in both groups. Conclusion The SCIT approach represents a safer and more functional approach for the removal of cysts and tumors of the pineal region than the classic midline approach, while maintaining the same effectiveness.
Neurological Research, 2020
Objective: The supracerebellar infratentorial (SCIT) approach is frequently used for the treatment of lesions in the pineal and posterior third ventricle region and can be performed in a sitting or prone position. We describe our experience with the purely endoscopic SCIT approach, using a prone position, with neck extension and head rotation. Methods: We analysed all paediatric and adult patients operated on between July 2013 and January 2018 using the purely endoscopic SCIT approach. The surgical procedure was conducted through a paramedian subtorcular keyhole suboccipital craniotomy. The assistant held the endoscope and the surgeon used fine, long shaft instruments for bimanual tumour dissection. The prone position with head retroflexion allowed a gravity-aided enlargement of the anatomical surgical corridor between tentorium and cerebellum and enhanced venous blood drainage, similarly to the sitting or semi-sitting position, but with a decreased risk of air embolism. Results: The approach allowed a complete removal of lesions located in the pineal region and in the posterior part of the third ventricle. Seven patients have been operated with this approach. All of them had the tumour completely removed. No permanent neurological deficits have been observed. Conclusions: The endoscopic SCIT approach enables effective and safe removal of pineal and posterior third ventricle lesions, even of moderate dimensions (up to 3 cm). The endoscope guarantees a detailed view and illumination of the deep-seated structures. The tumour resection can be performed with bimanual use of microsurgical instruments.
Endoscopic Approach to the Pineal Region
Operative Techniques in Neurosurgery, 2005
There are three goals in the treatment of pineal tumors: diverting cerebrospinal fluid (CSF) in the case of hydrocephalus, obtaining tissue for diagnosis, and obtaining CSF to identify biological markers. Neuroendoscopy can accomplish all these goals. Two routes can be used to treat pineal tumors. In the transventricular transforaminal approach, the pineal mass is exposed from its anterior aspect. The other route is posterior from a supracerebellar infratentorial approach that resembles the standard surgical approach. It is crucial to recognize that the aqueduct may be compromised and a third ventriculostomy may need to be performed.
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA
Introduction: Despite the deep-seated location of pineal region tumors, surgical resection has become safer and more effective, and now plays an essential role in their management. Tissue diagnosis allows the initiation of chemotherapy or radiotherapy, and resection can be curative or improve the efficacy of adjuvant therapies. Objective: Infratentorial supracerebellar (ITSC) and occipital transtentorial (OTT) approaches are the most used for pineal tumors resection. This study aims to describe feasible criteria for better approach indication based on our surgical experience. Methods: Forty-two patients were divided for tumor resection, using tentorial surface angle in sagittal MRI view in the approach selection: Group 1 (25 ITSC); Group 2 (15 OTT); Group 3 (two combined approaches). Results: Group 1 achieved successful total removal. It was observed one visual impairment, one hydrocephalus patient with postoperative meningitis, and other one with postoperative hematoma. Group 2 pre...
Full Endoscopic Infratentorial Supracerebellar Approach to Lesion of Pineal Region-Case Report
2019
Introduction: The supracerebellar infratentorial approach was originally described by Sir Victor Horsley, and was later adapted by Stein who applied the microsurgical technique improving the results of surgeries of the pineal region. Objectives: To highlight and systematize the indications, technical-anatomical details in the supracerebellar infratentorial approach based on our surgical experience and the review of the microsurgical anatomy of the Pineal region. Material and Methods: A retrospective descriptive study was carried out analyzing the clinical histories of six patients surgically intervened by the author in the aforementioned hospitals, through a full endoscopic supracerebellar infratentorial approach, between January 2013 and June 2019. Results: During the 2013-2019 periods, 6 patients underwent surgery. All of them underwent a full endoscopic supracerebellar infratentorial approach. 3 tumors of the pineal region, 1 Pilocytic Astrocytoma and 2 Arachnoid Cyst were treate...
World neurosurgery, 2018
In the last decades endoscopic techniques have been increasingly used in neurosurgery as they may offer a valuable close-up view of the working area through a minimally invasive surgical corridor. Herein, we present an inexpensive and efficient endoscopic surgical model using a borescope, which was used for a "modified pure endoscopic approach" to the pineal region. A borescope video camera was connected to a 16 inches personal computer monitor. A standard midline suboccipital craniotomy was performed on 2 cadaveric heads in the Concorde position. Then, a "borescopic" supracerebellar infratentorial approach was executed, thus reaching the pineal region which was exposed through an extensive arachnoid dissection. Using the above described model, we were able to provide excellent exposure of the main neurovascular structures of the pineal region, as showed by the intraoperative videos. In one of the specimen we identified an incidental pineal cyst that was meticulo...
Interhemispheric occipital transtentorial approach to the pineal region and dorsal midbrain
JBNC - JORNAL BRASILEIRO DE NEUROCIRURGIA, 2018
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.